Haviland Insurance

INSURANCE > WORKERS' COMP QUOTE

For a Workers' Compensation Insurance Quote please provide the following information (much of which is on your insurance declaration page).

Complete the form below then click the "submit" button to send the form.

YOUR INSURANCE INFORMATION

Payroll for each of your classifications (typically for apartments there are two classes - On Site Managers 9011 and Clerical 8810):	9011: 8810: Other Class and Payroll:
Your current insurance company:
Policy Expiration date:
Estimated dollar amount of each claim in the last 3 years:	1st Claim Amount 2nd Claim Amount
Your current annual premium:

YOUR CONTACT INFORMATION

Name:
Phone:
Fax:
Email:
Comments:

Password

Forgot your Email or password?

Need to enroll?

CERTIFICATES OF INSURANCE

If you need a certificate of insurance please contact one of the following:

Condominium owners/Homeowners
contact our San Diego Office at:
Email: certs@havilandinsurance.com
Phone: (619) 298-7292
Fax: (619) 298 7866

For all other requests:
Email: crs@havilandinsurance.com
Fax: (858) 225-0118

QUESTIONS?

Toll Free: (800) 466-6902
Phone: (858) 523-9737
Email: tim@havilandinsurance.com


	Haviland Insurance (Lic #0670678) · 1155 Camino Del Mar #507, Del Mar, CA 92014 · Phone: 800.466.6902 · Email: csr@havilandinsurance.com Copyright © 2008 Tim Haviland and Haviland Insurance Agency. All rights reserved.