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Workers' Comp Class Code
Please enter a value less than or equal to
4
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Employees by Class Code & Description
Workers' Comp Class Code
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4
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4
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Legal Name
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% Of Ownership
Legal Name
First
Last
Corporate Title
Sole Proprietorship
Partner
President
Vice President
Secretary
Treasurer
LLC Member
Stock Holder
Other
% Of Ownership
Legal Name
First
Last
Corporate Title
Sole Proprietorship
Partner
President
Vice President
Secretary
Treasurer
LLC Member
Stock Holder
Other
% Of Ownership
Legal Name
First
Last
Corporate Title
Sole Proprietorship
Partner
President
Vice President
Secretary
Treasurer
LLC Member
Stock Holder
Other
% Of Ownership
Four Years of Carrier History
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1st Year Previous Carrier
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2nd Year Previous Carrier
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