Downloadable PDF Forms
Census of Employees Eligible for Benefits
Individual Insurance Quote Request Form
Certificate Request Form
Workers Comp Claim Form
Current Coverage Questionnaire
Workers Comp Waiver Request Worksheet
Employer's Report of Injury Form: 5020
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Main Office:
1835 North Fine Ave. Fresno, CA 93727
Phone:
(559) 650-3555 or (800) 628-8735
Fax:
(559) 650-3558 or (800) 440-2378
License No:
0755906
