Form A-1 Application For A Private Entity Certificate Of Consent To Self Insure {A-1}

Form A-1 APPLICATION FOR CERTIFICATE OF CONSENT TO SELF-INSURE AS A PRIVATE EMPLOYER SELF-INSURER. The form is an application for a Certificate of Consent to self-insure workers' compensation as a private employer self-insurer in California. The applicant must provide information about their business, ownership structure, and claims administration. The form includes questions about the nature of the business, workers' compensation history, and security deposits. The form also requires information about workplace safety, the legal structure of the business, and claims administration. An authorized representative must sign and submit the form, along with a checklist of required documents and a filing fee. www.FormsWorkflow.com