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Workers' Compensation -
Western Region/CA

Tools And Applications

Download everything you need for a complete submission.

Workers Compensation

Submission Requirements
Submission Checklist

Fillable ACORD® Forms Library & Samples
State Specific ACORD® Forms - Workers Compensation Loss Reports
State Specific ACORD® Forms - Workers Compensation Series
ACORD® 130 - Workers Compensation Application

Agent Information Form
Camper/Athletic League Submission Form
Chartis Staffing Supplemental Form
Contractors Supplemental Application
Nursing Home Application
Special Risk Application
Surety Bonds for Self Insured Workers' Comp
Trucking Supplemental Application
Waste & Public Transportation Supplemental Application

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© 2015 5Star Specialty Programs is a division of and operates under the licenses of CRC Insurance Services, Inc. CA Lic No 0778135. No claim to any government works or material copyrighted by third parties. Nothing in this communication constitutes an offer, inducement, or contract of insurance. Financial strength and size ratings can change and should be reevaluated before coverage is bound. This material is intended for licensed insurance agency use only. This is not intended for business owner or insured use. If you are not a licensed agent please disregard this communication. 5Star Specialty Programs supports a diverse workforce and is an Equal Opportunity Employer who does not discriminate against individuals on the basis of race, gender, color, religion, national origin, age, sexual orientation, gender identity, disability, veteran status or other classification protected by law. Drug Free Workplace.