California Contractor Insurance | Grand Commercial Insurance Brokerage LLC


What is your experience modification percentage? If any.

What classifications (4 digit) are used and what is estimated annual payroll for these classifications? Classification Annual Payroll Classification Annual Payroll Classification Annual Payroll Classification Annual payroll Contact person? Phone number? Fax number ? Cell number ?
What is your e-mail address ?

Please fax 2 or 3 months or quarters of your last billing statements from your workman's comp carrier.

Who is your current work comp carrier?

If you do not have prior insurance, how many years of experience do you have

What is your federal I D number? ...or Social Security Number

What is your contractor license number?

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click here to print FAX TO US @ (866) 462-7090 • CALL US @ (800) 809-1730 WORKMAN'S COMPENSATION-CALIFORNIA ADMITTED CARRIER PHONE # 800-809-1730 FAX #866-462-7090 LICENSE# OE48187