Workers Compensation Application
For your convenience, here are several applications you can download yourself to complete. All applications are in PDF format and can be read using Acrobat Reader. If you do not currently have Acrobat Reader on your computer, you may DOWNLOAD it for free.
If you do not see an application here for the coverage you are interested in, call our office and we will take care of you either over the phone or by mailing or faxing you an application.
To view our pdf files you will need Adobe Acrobat Reader - click here to download.
Some of these applications are form fill, SAVE before you send it in. Others must be printed and filled out by hand.
Workers Compensation Application - California:
We are happy to provide you with this vital coverage for various horse related operations whether you have had prior coverage or simply want to quote your existing coverage elsewhere. We offer coverage through State Fund as well as other insurers who are A rated. Simply download and complete the questionnaire and send it back to us. If you have coverage now, attach hard copy loss history from your insurer(s) for the past four years. If you simply want us to contact you closer to your renewal, email us with your renewal date (firstname.lastname@example.org) and we will follow up with you.
Download Workers Compensation Application