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Kinetic

Kinetic

Reinventing Workers Comp Insurance in the Age of Technology.

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Officer Exclusion & Inclusion Forms

If you request a quote that requires officer exclusion or inclusion forms, please find them below.

Once you have filled out all required materials, please email your completed submission to submission@kinetic-insurance.com

Nationwide Officer Exclusion Form

Nationwide Officer Inclusion Form

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Workers comp insurance that works
smarter for brokers and policyholders.

(833) 550-0388
info@kinetic-insurance.com
California License #6005906

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