By continuing, I declare that the above answers and statements are true and correct to the best of my knowledge.

Please upload a file with each workers' compensation class code listed individually -- if you do not currently have workers' compensation insurance, please complete the number of employees under each job description as well as their combined yearly remuneration. If you currently have a workers' compensation policy, please also list your current rates for each class code.
 
Please include:
State
Code (If known)
Class Code Description
Effective Rate Per $100 of Payroll (If known)
# Full-time Employees (Over 30 hrs/week)
# Part-time (Under 30 hrs/week)
Estimated Annual Payroll

Workers' Comp Classification #1