Form S-1 Group Master Application For Certificate Of Consent To Self Insure {S-1}

Form S-1 - GROUP MASTER APPLICATION FOR CERTIFICATE OF CONSENT TO SELF-INSURE AS A GROUP SELF-INSURER. This form is used to apply for a certificate that allows a private group to self-insure for itself and obtain affiliate certificates for each group member to secure the payment of workers' compensation under California Labor Code Section 3700. The application requires detailed information about the group, including the name, address, and federal tax ID of the group, as well as information about the group’s state and date of incorporation. The form must also provide the contact information for correspondence regarding the group, the commencement date of the group, and details about whether the group currently has a California Certificate of Consent to Self-Insure. Additionally, the application includes information about the group’s claims administration, a checklist of required documents and forms, and detailed requirements for feasibility studies and supplemental information such as excess insurance coverage, fidelity coverage, and errors and omissions coverage. www.FormsWorkflow.com