PREMIUM AUDIT REPORT - Chesapeake Employers Insurance Company 2026

1. Click ‘Get Form’ to open the PREMIUM AUDIT REPORT in the editor.
2. Begin by entering the date, company name, policy number, and policy term at the top of the form. Ensure accuracy as this information is crucial for your audit.
3. In the TOTAL PAYROLL INFORMATION section, fill in each line item carefully. Start with your total gross payroll for the policy period and follow through by subtracting tips and one-third of total overtime. Add any miscellaneous labor or uninsured subcontractors as needed.
4. For EMPLOYEE PAYROLL DETAIL, list each employee's class description along with their average payroll and overtime details. This section excludes officers and LLC members.
5. Complete the OFFICER / LLC MEMBER PAYROLL AND OWNER/PARTNER INFORMATION section by providing names, titles, duties performed, and gross wages. Indicate if these wages are included in line A.
6. In the UNINSURED SUBCONTRACTOR AND MISCELLANEOUS LABOR section, document subcontractor names, duties performed, and amounts paid. Remember to group miscellaneous labor amounts by type of work performed.
7. Fill out any OTHER INFORMATION required at the end of the form, including sales/revenue totals and comments. Attach necessary documentation as instructed.

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