• Fully completed and signed Workers Compensation Acord 130 application
• Fully completed and signed Beacon Supplemental Application for Temporary Employment
Agencies/Employee Leasing Companies (Please refer to the 'Forms' section of our website)
• Full names and physical addresses of all Rhode Island client companies that the temporary
employment agency/leasing company does business with
• A copy of the executed contract between the temp agency/leasing company and each Rhode
Island client company
• Most recent experience modification worksheet
• Recently valued, hard copy prior carrier loss runs for the past four years
• Proof of coverage for all other states in which the temporary employment agency or employee
leasing company may place employees
Beacon Mutual has additional underwriting requirements which pertain to all out of state employers
requesting Rhode Island coverage.
If the temporary employment agency or employee leasing company for whom coverage is being sought
does not have a physical location within the state of Rhode Island, please refer our "Agents" tab and the
posting dated 4/10/07 titled "Out of State Employers." The "Out of State Employer" application
requirements are in addition to Beacon's standard temporary employment agency/employee leasing
company application requirements.
• The underwriter will review your application for completeness, and may request additional
information or clarification prior to providing you with a quotation.
• A preliminary audit or loss control survey may be required prior to quoting.
• Once we provide you with a quotation, a premium deposit (and any additional information as
noted on the quotation letter) will need to be received one day prior to the requested coverage
• Please refer to the 'Forms' section of our website for Beacon Mutual's Requirements pertaining
to temporary employment agencies and employee leasing companies once coverage is bound
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