Please Complete the Workers Comp. Pre-Application Below. Or give us a call at: 800.286.5950 Ext# 712. * The NEW ContractorsGUARD Workers Comp Program is Now Available for California Contractors and Only Available through The Contractors Resource Center and Approved Brokers. First Name*Last Name*Phone*Email* How did you hear about us?*SelectKevin LeipsicPlacer Contractors SchoolAustin DieleColonial LifeADPText MessageContractors Resource Center WebsiteFacebookRadio AdGoogle SearchOtherCompany Name*CSLB #*FEIN #Estimated Total Annual Payroll*PLEASE TELL US ABOUT YOUR EMPLOYEESHow Many Full Time Employees Do You Have?*Total Estimated Payroll for Your Full Time Employees*How Many Part Time Employees Do You Have?*Total Estimated Payroll for Your Part Time EmployeesHave you had any losses in the last 5 years?*NoYesIf you had a loss in the last 5yrs, please briefly explain the lossWHAT TYPE OF WORK DO YOU DO?What Percentage of Your Work is Residential?Zero10% to 20%20% to 50%50% to 75%75% to 100%What Percentage of Your Work is CommercialZero10% to 20%20% to 50%50% to 75%75% to 100%What Percentage of Your Work is New Construction?Zero10% to 20%20% to 50%50% to 75%75% to 100%CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.