Minnesota Workers Comp Insurance Quote

Baecker Insurance Agency
of Saint Paul, MN offers
affordable Business Insurance
coverage options and
experienced business insurance
services throughout
Minnesota.

Contact us about Property,
Liability, Owners, Auto, and
Workers Comp Insurance for
your Minnesota business toll
free at 1-877-730-4678 or
locally at (651) 730-6666.

In addition to Minnesota
Workers Comp Insurance, we
also offer affordable Group
Health Insurance plan services.

We are your local St. Paul, Minnesota insurance agency, offering experienced
Workers Compensation Insurance services to businesses in the following Twin
Cities area towns and counties: Minneapolis, Bloomington, Roseville, Maplewood,
North St. Paul, Oakdale, Woodbury, Cottage Grove, South St. Paul, Inver Grove
Heights, Eagan, West St. Paul, Richfield, Burnsville, Edina, Lilydale, Mendota
Heights, St. Paul Park, Lake Elmo, Newport, Cedar Grove, Savage, Shakopee, Eden
Prairie, Minnetonka, Hopkins, St. Louis Park, Plymouth, Golden Valley, Columbia
Heights, New Hope, Crystal, Robbinsdale, Brooklyn Center, Fridley, New Brighton,
Maple Grove, St. Anthony, Arfen Hills, Shoreview, Vadnais Heights, Little Canada,
White Bear Lake, Mahtomedi, Grant, Bellaire, North Oaks, Gem Lake, Mounds View,
Lino Lakes, Blaine, Coon Rapids, Spring Lake Park, Lexington, Afton, Lakeland,
Bayport, Stillwater, Apple Valley, Andover, St. Cloud, Mankato, Rochester, Duluth,
Anoka, Champlin, Andover, Oak Grove, St. Michael, Hanover, Scandia, Forest
Lake, Wyoming, Rosemount, Hastings, Vermillon, Coates, Ramsey County,
Hennepin County, Dakota County, Anoka County, and Washington County, MN.
We also offer business insurance services in the remainder of Minnesota and
throughout Wisconsin.

**Information received from this Workers Compensation Insurance quote
request form sent to the Baecker Insurance Agency will be for our use only
and will not be sold, given to or distributed to any other parties. A quote will
be based on the workers compensation insurance policy plan information
provided and does not guarantee acceptance of the risk by us. The precise
coverage afforded is subject to meeting underwriting guidelines, and the
terms, conditions and exclusions of the policy as issued. By submitting
this request you acknowledge that this is neither an offer to insure nor a
guarantee of insurance. Completion of this form does not entitle your
business to a Minnesota Workers Compensation Insurance Policy. We are
licensed in Minnesota and Wisconsin and will not provide quotes for other
states.

Business Name:
Premises Address:
City:
State: (Minnesota or Wisconsin)     Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required)

Federal Employer's ID #:
Description of Operations or SIC code:

# of full-time employees:     # of part-time employees:
# of locations:     Estimated Annual Payroll: $
Experience Mod (if any, per policy)

Select all that apply to your Minnesota business:
Operate or lease aircraft/watercraft     Work Underground
Work above 15 feet                           Require out of state travel
Use Subcontractors                            Delivery Service
Pre-employment physicals                   Offer safety incentive programs
Store, treat, dispose, or transport hazardour waste
Work on vessels, docks, or bridges over water
Other

Current Insurance Company:
Policy #: Expiration Date: (mm/dd/yyyy)
What types of coverages do you currently have:
Commercial Auto
Commercial Liability
Commercial Property
Commercial Umbrella
Directors & Officers Liability
Disability
Group Health
Group Life
Professional Liability
Other

Other Insurance Company Used Within Past 3 Years:
Policy #:
Losses past 3 years:
Description of losses or loss runs:

Employee       Classification Code       Yearly Payroll Estimate
      1                                         $
      2                                         $
      3                                         $
      4                                         $
      5                                         $

Principal             Name                                          Title                        Include
      1
      2
      3
      4

Additional Information or Comments

Click on the "Submit Quote Information" button below to send
your Minnesota Workers Compensation Insurance quote request.**

Minnesota Business Information:

About Your Minnesota Business:

Recent Insurance Information:

Employee Information:

Officers / Partners / Owners Information: