Please submit the following items in order to obtain a quote::

1. A completed (all sections including prior loss experience and questions) Acord Workers’ Compensation application #130 or #130FL for Florida.
2. Prior carrier loss runs for the past 3 years including the expiring year, valued within 90 days prior to the proposed effective date.
3. A detailed description of all claims with a total incurred amount of $25,000 or more.  Expected information should include the injured employee’s occupation, what he/she was doing when the injury occurred, and cause of injury.
4. The most current experience modification worksheet or snap shot.

For more information, please contact:
Nikki Carpenter
Apollo General Insurance Agency, Inc.
P.O. Box 1508, Sonoma, CA 95476
Phone: 707-996-2912; 800-624-5829, ext.12;
Fax: 707-996-7912
Contact Us Via E-mail
We welcome your business!

Attention brokers: If you are not already doing business with Apollo General
Insurance Agency, please click on the new brokers link on our programs page.