Alliance of Schools for Cooperative Insurance Programs

ascip

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  • COVID-19
    • Reopening Schools Planner
  • About
    • Calendar
    • Financial Strength
    • Governance
    • Members
    • News & Updates
    • FAQ’s
  • Insurance for Schools
    • Coverages
    • Property & Liability
    • Workers’ Compensation
    • Health Benefits
    • OCIP – Construction Insurance for Schools
    • Request A Quote
  • Risk Services
    • Member Shared Resources
    • Risk Management Prevention Services
    • Guidelines & Best Practices
    • Sample Agreements & Forms
    • Abuse Prevention Resources
    • Special Education Resources
    • Risk Alerts & Bulletins
    • Lessons Learned – Sharing Experiences
    • Safety Spotlight Resources
    • Additional Resources and Forms
    • FAQs
  • Training
    • 2022 Virtual Annual Membership Meeting
    • Online Training
    • Seminars & Webinars
    • Resources
  • Forms & Tools
  • Contact

Workers' Compensation

Home > Insurance for Schools > Workers’ Compensation > Request a Quote
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Request a Quote

Workers' Compensation Program
  • Download the PDF version of this form
  • 2. Workers’ Compensation Coverage Exposure

    Please provide the following information. Payroll includes gross wages, salaries, bonuses, vacation, holiday and sick pay, overtime payments and all substitutes for money earned during the policy period by employees, (full-time, part-time, and temporary) and officers of your District and other persons for whom voluntary coverage is provided under the policy.
  • Current Year (Estimated)

  • First Previous Year (Actual)

  • Second Previous Year (Actual)

  • Third Previous Year (Actual)

  • Fourth Previous Year (Actual)

  • Fith Previous Year (Actual)

  • Sixth Previous Year (Actual)

  • (Please write in the number of claims, zero or unknown in the blank)
  • This field is for validation purposes and should be left unchanged.

Contact Info

Main Office/Southern California Claims Handling:
16550 Bloomfield Avenue
Cerritos, CA 90703

Northern California Claims Handling:
1531 "I" Street, Suite 100
Sacramento, CA 95814

Email: ascip_info@ascip.org
Phone: (562) 404-8029
Fax: (562) 404-8038
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