In order to keep your Workers' Comp records up to date, please complete the form on this page.
To make this process as convenient for you as possible, we are providing a number of options to provide us with this form.
ONLINE: Complete the form on this page and click the submit button.
BY FAX OR BY MAIL: If you prefer to fax or mail us the form, click the PDF icon below and a form will download for you to complete.
You can enter your information into the form, after which we suggest you save the completed form for safekeeping. You can then print it and either fax it to (559) 650-3558
Mail it to:Workers' Compensation DepartmentLandscape Contractors Insurance Services, Inc.
1835 N. Fine Ave
Fresno CA 93727
Call us at (800) 628-8735 or send us an email.