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Workers Compensation

Workers Compensation Insurance assures the employees of financial help in the event of workplace-related illnesses, injuries, and diseases. Likewise, it secures the business owner against possible liability claims arising from the said accidents.
* =Required Fields >
* Name:    
* Email Address:    
Entity:         Corporation Individual Partnership Other
Phone #: Fax:
Years in Business: Years Experience in the Field:
Federal Employer ID #:    
Brief Description of Business Operations:
Code Description Payroll # of Employees
Name of Officers/Owners Included
Health Provider: Average Hourly Wage:    
Do You Deliver?: How Often?:    
Out of State Employees?: Sick Pay?: Vacation Pay?:
3-Year Carrier History: Expiration Date:
Current 1 Year Prior 2 Years Prior
Name:   Name:   Name:  
Policy # Policy # Policy #

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When you fill out our form, you will receive health insurance quotes from Aetna, Anthem Blue Cross, Blue Shield of California, Health Net, PacifiCare & United Health Care. We'll help you find individual, family or small business health insurance and the best medical insurance plans for your needs and budget.