Save on Worker’s Comp!

California premiums have dropped dramatically over recent months. New programs are available and now is a great time to see what we can do for you.

 

Just fill out below and click submit, and we will shop all the available options. Or, if you prefer, call us at 800-591-9692 and work directly with a licensed contractor insurance specialist.

 

Request a Quote

SECTION 1 - Your Information

* Business Name:
     
* Contractor License Number:
     
  How did you hear about us?
Referral if so by
Online Search
Current Client
Had Prior First Service Policy
Phone Book
Other
     
  Owner/Contact Name:
     
* Business Phone:
     
  Fax:
     
* Email:
     
  Description of your operation:

 

SECTION 2 - Your Coverage Details

  Estimated Total Annual Payroll (all classes): $
     
  Estimated Payroll by Class:
     
  If you have a breakdown of Estimated Annual Payroll by Class, provide below:
1 Class:
  Annual Payroll:
 
2 Class:
  Annual Payroll:
 
3 Class:
  Annual Payroll:
 
4 Class:
  Annual Payroll:
 
5 Class:
  Annual Payroll:
     
  FEIN #:

 

SECTION 3 - Your Coverage History

  Current Insurance Carrier:
     
  Policy Expiration Date:
     
  Any claims in the last five years?
Yes, if so please provide a brief detail of the number and the $ amount of claims with dates. We will work to get the best quotes and be in touch for more detail.
 
No claims.
     
  Are you satisfied with your old broker's service?
Yes
No, then What is the problem with your old Broker?
 

 

Please note that insurance transactions, – requests to incept, change or otherwise alter coverage, – are NOT effective without written acknowledgement from the carrier issuing coverage. First Service will notify you in writing when the carrier has confirmed your request.

 

LIC #0C13473

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