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Contact info

  • PO Box 5217
    Huntington, CA 92615
    Phone:
    714-593-6414
    Fax:
    714-593-6104
    Email:

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:    
Website:    
Entity:         Corporation Individual Partnership Other
Company:    
Address:    
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
1.    
2.    
3.    
4.    
 
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 #
     
* Enter Security Code:  
   
     
 
You will receive affordable health insurance quotes from all of the following insurance providers...



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.