Affinity Global Insurance

Workers Compensation

National and global insurance for our commercial clients

We offer businesses the protection required for their workers compensation, liability , auto and property insurance policies

Insurance Solutions for Your Healthcare Facilities

Healthcare Programs for:

Nusing Home
Residential Care Homes / Assisted Living
Hospitals / Sub Acute Hospitals
Physicians / Physician Groups
Allied Health
For Profit and Non Profit CCRC's
We have exclusive access to HCF Insurance Programs www.hcfinsurance.com

Affinity Global Entertainment

Affinity has expertise protecting Business Manager's High Net Worth clients for both Commercial and Personal Lines assets. Combining both a full time Claims Manager with a full time Litigation Attorney gives our clients the claims support they need in this litigious environment. We aslo provide dedicated Account Executives and Account Managers to provide unparalleled customer service 7 days a week. Our Errors & Omissions limits is one of the highest in the industry to give you, the Entertainment Manager's a sense of comfort protecting the unknown from occuring.

Insurance Solutions for Your Personal Insurance

Automobile Individual and Families

Home Including Rental Properties, Vacation Homes & Investment Properties

Unbrella Coverages

Classic Vehicle Programs

Health and Life Insurance Programs

Contact Us

(818) 746-3083 Main Line

21747 Erwin Street, 2nd Floor
Woodland Hills, CA 91367

License Number 0G72972

Workers Compensation Application

All fields are mandatory.

Insured Information

Name of Business:

FEIN Number:

Nature of Business:

Number of years with workers' comp Insurance:

Any exposures outside of this state?YesNo

If so Which State(s):

Contact Name:FirstLast

Contact email address:

Contact phone number: - (###) - #######

# of Locations: *If additional locations are present please complete the 3 locations here and further locations can be discussed via phone/email

#1 Location Workers Compensation Information

#1 Estimated Annual Payroll:

#1 Name of officers & owners:

#1 Normal Anniversary Date of Workers Compensation renewal:

#1 Last Years Annual Premium:

#1 Current WC Insurance Carrier:

#2 Location Workers Compensation Information

#2 Estimated Annual Payroll:

#2 Normal Anniversary Date of Workers Compensation renewal:

#2 Last Years Annual Premium:

#2 Current WC Insurance Carrier:

#3 Location Workers Compensation Information

#3 Estimated Annual Payroll:

#3 Last Years Annual Premium:

#3 Normal Anniversary Date of Workers Compensation renewal:

#3 Current WC Insurance Carrier:

OPTIONAL:

UPLOAD LAST 3-5 YEARS OF LOSS HISTORY REPORTS

Leaf Blanc