Occupational Accident optout general contractor

Jackson - Lloyd Insurance Management

1615 Judson Road, Longview, TX 75601 P.O.Box 187, Longview, TX 75606

800-657-5242

903-758-6206

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TEXAS:

QUICK QUOTE - TEXAS

TEXAS FORM DWC-005 02/18

TEXAS FORM DWC-005 VIDEO

TEXAS AGENT PACKET

KANSAS:

QUICK QUOTE - KANSAS

KANSAS AGENT PACKET

ALL STATES:

CERTIFICATE REQUEST

TRANSPORTATION SUPPLEMENT

VERIFICATION OF LOSS HISTORY

WALL POSTER: ACCIDENT / INJURY REPORTING PROCEDURES

FIRST REPORT OF INJURY