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  Current Insurance Company (Not Brokerage) :   No Prior Coverage
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  Claims in Past 3 Yrs: Yes    No
     
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  Workers Compensation Supplemental:  
 
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  Do You Provide a Blue Cross Group Health Plan: Yes    No
     
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Address: 1041 W. 18th Street, Suite A204, Costa Mesa, CA 92627 Phone: (800) 987-5051
Excelsure

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