Quote Your Own Workers’ Comp Insurance Please enter the information from your current policy to calculate your insurance quote. First Name* Last Name* Email Address* Company Name* Current Policy Expiration* Experience Modification Number (Not applicable for policies under $5,000 in premium) Annual Sales Volume (Sales Volume Calculation) Add New Class Code Standard Premium $ Foreign and Domestic Terrorism Risk Coverage $ Natural/Industrial Catastophe Mix $ Experience Modification Adjustment $ Premium Discount $ Subtotal $ 0.00 NYS Assessment (12.2%) $ Expense Constant $ Estimated Annual Premium Without Dividend $ Administrative Fee * $ Retail Council Dues * $ Total Premium, Dues and Fees $ Group 493 Dividend (2017 Dividend 40%) $ PROJECTED ANNUAL COST $ Online insurance quotes are not applications for insurance or an insurance policy. Online quotes are estimates only, based on information you provide, and are subject to change based on verification of information, including payroll and claim history. Receipt of an online insurance quote does not guarantee that your application will be accepted should you apply for insurance. Underwriter review and approval will be required before a formal offer of insurance coverage can be made. To receive a formal offer of insurance, please contact Bill Rabbitt - 800-442-3589 or BillRabbitt@rcnys.com. Safety Group 493 Workers’ Compensation Insurance is available only to members in good standing of the Retail Council of New York State, Inc. *Administrative fee calculation: 9% of the first $20,000 in premium (Administrative Fee Premium Subtotal) + 2% of premium over $20,000. **Annual dues is calculated based on sales volume. Minimum dues is $100.