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What is your experience modification percentage? If any. |
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What classifications (4 digit) are used and what is estimated annual payroll for these classifications? Classification
Annual Payroll
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What is your e-mail address ? |
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Please fax 2 or 3 months or quarters of your last billing statements from your workers comp carrier. |
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Who is your current work comp carrier? |
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If you do not have prior insurance, how many years of experience do you have |
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What is your federal I D number? |
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What is your contractor license number? |
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Comments |
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| FAX TO US @ (866) 462-7090 • CALL US @ (800) 809-1730 WORKERS COMPENSATION-CALIFORNIA ADMITTED CARRIER |
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