Request Your Free Workers’ Comp Insurance Quote

To request a quote, please complete the form below and attach your most recent policy declarations page; if you are a broker, you can attach a completed ACORD. You can also include your most recent premium audit and last five years of loss runs to expedite a review of your submission by our Safety Group underwriter.

You can also fax your information to (518) 465-7960 or email Virginia ( or Bill (

What to expect from your quote >

    Business Name*

    Contact Name*

    Business Street Address*

    City / State / Zip*

    Telephone Number*

    Email Address*

    How Did You Hear About Us?


    Attach Your declaration page

    What to expect from your quote

    Our quote will take into account your payroll and current experience rating, as well as any applicable discounts and a potential year-end dividend. Once we receive your policy information, we will contact you within two business days with a provisional quote. We will show you all the costs involved to be a member of our Safety Group: [Hint: there are no hidden fees].

    Your information is strictly confidential. The Retail Council does not share any of your data.