Broker Requirements
In order for Keevily to help you provide cost effective, high-quality NY Workers’ Compensation insurance options to your clients, please submit the following information:
- Acord Commercial Application 125 and Workers’ Comp App 130; or current carrier Declarations page. If the insured is in State Fund Group 90, please submit the most recent declaration
- Latest Worker’s Compensation Audit Billing
- 5 Year Loss History
- Provide Information on Additional Entities
- Please let us know if this account has previously been insured with the State Insurance Fund.
Contact us for a quote info@keevily.com
Business submissions:
800-523-5516 Fax: 914-381-1134