Dental Coverage

Insurance Resources

coverageglossary.com
Insurance Resource

www.iii.org
Insurance Resource

hwysafety.org
Automobile Resource

cslb.ca.gov
Remodeling Resource for Homeowners

wcirbonline.org
Workers' Compensation Resource

www.fema.gov
Disaster/flood Resource

earthquake.usgs.gov
Earthquake Resource

quake.abag.ca.gov
Earthquake Resource

California Dental Offices Save Big on Workers Compensation!
Are you currently insured with the California Dental Associations' Recommended
Insurance Provider? You may be paying too much. Complete our
questionnaire for a Low rate, no obligation quotation.

If you would like to discuss the Dental program with one of our insurance professionals please fill out the following information. A member of the CFP team will contact you accordingly.

Please take a moment to fill out the following Questionnaire.

If you have specific questions e-mail CF&P or give us a call at 510-433-4200

CF&P Agent
Named Insured:
Location Address:
Number of years in business:
What type of Office is this business (General, Endodontic, etc.)?
Contact Name:
Contact Phone Number:
Contact email address:
Type of Ownership (Corp, LLC, Partnership, etc.):
Names, Titles & Percentage of Ownership of Corporate Officers or Owners:
Federal Employer ID#:
Annual Payroll Not Including Officers/Owners:
Officers/Owners Annual Payroll Amount:
Number of Employees:
Are Health Care Benefits Provided for All Employees?
If yes, what is the name of the Provider?
Average hourly wage:
Current Experience Modification Factor:
Any losses in the past four years?
If yes, please provide date of loss, description of injury & amount incurred:
Quotations are subject to four years of acceptable loss history prior to binding.