*PEO Services Needed: Check all that apply |
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Other / Special Services Needed:
*Description of Operations:
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*Tell us about your Worker's Compensation Program:
Average Gross Payroll per Week: $
Annual Payroll: $
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Policy Renewal Date:
Experience Modifier Rate:
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*Employee Workers' Compensation Classification / Code / Annual Payroll |
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*State Unemployment:
Current Number of Employees:
W-2s processed last year:
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Current State Unemployment Rate (SUI)
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Number of unemployment claims in last 12 months:
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Tell us about your Employee Benefits:
Do you currently provide Benefits to your Employees?
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Benefits you provide:
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Tell us about your current Business Insurance coverage: (Check all that apply) |
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Estimate of Present Administrative Costs (as a percent of payroll):
Administrative costs should include all costs associated with your company providing complete (1) Human Resources administration, (2) Workers' Compensation, Risk Management & injury claims administration, (3) Payroll processing and payroll tax compliance, (4) Unemployment Claims processing & (5) Group Benefits administration. (These costs must include all staff & management payroll, associated payroll taxes, benefits for staff employees in these departments; including vacation pay, holiday pay, the equipment and supplies they utilize, rent space, departmental utilities, legal fees, professional fees (all operating costs associated with the specific departments mentioned above).
For assistance in calculating your administrative costs, click here: Administrative Cost Calculator
Note: A recent Small Business Administration study showed an expenditure in the range of 4 - 12%, with an average of 8.43% of payroll costs to provide the above administrative services. |
Any specific questions or comments:
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How did you hear of dmDickason Staff Leasing Company?
If by a referral, please tell us who.
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