Section 3 - Payroll verification requirements
The premium for the audit policy term will determine if quarterly documents are required. Examples are: Federal 941 Quarterly Forms and/or State Unemployment Quarterly Forms.
Using the chart below, please locate the state where the majority or all the business is conducted. Was the premium greater than the premium threshold listed for the state below?
Yes, the premium was greater
No, the premium was less
DE, MA, NY, PA
All other states
Please upload your quarterlies during your expiring policy term.
It is encouraged to attach the quarterly forms now, as they may be requested by the auditor at the time of processing.
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Section 5 - Principals/Ownership
Have there been any changes to the entry type or the principal/ownership?
Please provide details of the changes and the date it occurred. Make sure to include applicable dates, name, title, percentage of ownership, job duties and gross compensation/draws/distributions.
Provide information about owners, principals, officers, LLC members, partners and proprietors.
If more than 5 principals/owners, attach a summary including names, titles, percentage of ownership, job duties and gross compensation/draws/distributions.
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Section 7 - Additional questions
Please indicate if you permit Markel to release the audit worksheets and audit information including payroll documentation to your agent or broker.
Do you have any of the following exposures?
- Asbestos removal
- Chemical manufacturing
- Wrecking or demolition
- Firefighters and police officers
- Off-shore or subaqueous work
- Railroad operation or construction
- Flammable liquids or flammable gases
- Aircraft flight or ground operations of any kind
- Sewer, subway, or water main construction, shaft sinking, or tunneling
- Underground mining, strip mining, or quarrying
- Caisson or coffer dam work; dam, dike, lock, or revetment construction
- Nuclear, radioactive, chemical, or biological contamination.
- Amusement parks or devices, exhibitions (including fireworks), carnivals or circuses, sports events and/or participants
- Maritime or federal employments; marine work of any kind, operation of drydocks, any U.S. Longshoremen's and Harbor Worker's exposures
- Explosives, substances intended for use as an explosive, ammunitions, fuses, arms, magnesium, propellant charges, detonating devices, fireworks, nitroglycerine, celluloid, or pyroxylin
- Gas companies, dealers, or distributors, except those in the gasoline service station business; oil or gas operators, lease operators or contractors; oil or gas well works; oil or gas pipeline construction or operations; oil rig and derrick work; onshore or offshore gas or oil drilling
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Section 8 - Audit contact information
Please complete this section with your information. Markel will send a copy of this online form to the insured’s email entered in Section 1, as well as your email listed below.
By clicking submit below, I certify that I am an authorized representative of the insured for the purpose of this workers compensation audit. I also certify that all information provided is complete and accurate, and understand that the email provided will receive a copy of this audit documentation.
Be advised that you only need to click the submit button once. You will see a confirmation once the form has been submitted successfully.
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