Workers' Comp Program BIAW

TO GET STARTED

FILL OUT THIS INQUIRY FORM TO LEARN MORE

When you complete the form, we will also provide you with a refund calculation so you can see
how much you could have earned if you were enrolled in R.O.I.I.® Select.

Please review my premium and loss information to see
if R.O.I.I.® SELECT might be a good fit for my company.

 
 
 
 
 
 
 
 
 
 
   

This is not an application for enrollment.

Signing this release gives BIAW permission to contact anyone at the above listed company via mail, email, and phone for any BIAW-related matters.

 TO DEPARTMENT OF LABOR & INDUSTRIES

 

You are hereby authorized to provide our company's premium, claims history, losses, statistics, experience modification factor, and related industrial data, including all sub-accounts tied to the policy whether inactive or active, to the Building Industry Association of Washington along with access to the Department's online Claim & Account Center.

Please sign the box using your mouse, finger, or stylus. We will notify you by email when we receive your submission.