Aniello Insurance Agency
Aniello Insurance Agency
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Aniello Insurance Agency
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Aniello Insurance Agency
Aniello Insurance Agency
Aniello Insurance Agency
3012 West Charleston Blvd.
Suite 150
Las Vegas, NV 89102
Phone: 702 259-0250
Fax: 702 259-0662
info@anielloinsurance.com

Aniello Insurance Agency Get A Quote
Aniello Insurance Agency
Aniello Insurance Agency
Aniello Insurance Agency

Get A Quote

Workers' Compensation Insurance Quote

We would like to provide you with a free, no-obligation Workers' Compensation insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

General Information
Name of Practice:
Contact Name:
Address:
City:   State:   Zip:
Practice Phone:   Fax:
Contact Email Address:

Current Insurance Information
Company Name (not agency):
Policy Expiration Date:   Premium Amount: $
NCCI Number:
NCCI Experience Modification Number:
What type of coverages do you currently have:
Bond
Commercial Auto
Commercial Liability
Commercial Property
Commercial Umbrella
Directors & Officers Liability
Disability
Group Health
Group Life
Professional Liability
Other  

About Your Practice
# of full-time
employees
# of part-time
employees
How long
in practice
How many
locations
Estimated Annual
Payroll
years
$
Please give a brief description of your practice (below):

Additional Practice Information
Do you have any losses in the past 3 years?: Yes No
Do you have Independent Contractors?: Yes No
If yes, how many?:
Do paychecks reflect the above name?: Yes No
If no, please provide details:
Federal Tax td:
Type: Corporation Partnership
Individual    Other
Average hourly wage for non-physician employees: $ / hour
List all Officers/Partners
Name: Title: % Ownership: Excluded/Included:
What is the practice specialty?
Off premise operations: Yes No

Employee Information
Employee#
Classification code
Estimate Yearly Payroll
1
2
3
4
5
Please list additional employees in the "Additional Comments" section below

Additional Comments
Please give any additional comments you feel appropriate for this quotation. If you have
additional information where there was not enough space, please enter them here.

Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.

   


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Aniello Insurance Agency

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Important Note: This website provides only a simplified description of coverages and is not a statement of contract. Coverage may not apply in all states. For complete details of coverages, conditions, limits and losses not covered, be sure to read the policy, including all endorsements.
Aniello Insurance Agency

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Aniello Insurance Agency