Oregon > Workers Comp > Proof Of Coverage - Insurer
Reinstatement Of Guaranty Contract 3217 - Oregon
| Reinstatement Of Guaranty Contract Form. This is a Oregon form and can be used in Proof Of Coverage - Insurer Workers Comp . |
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Reinstatement of Guaranty Contract Insert name of insurer and address where policy/coverage information is available: Employers legal name and mailing address: Policy no.: FEIN: BIN or WCD no.: This notice is to inform you that your workers compensation policy has been renewed, effective without a lapse in coverage. The cancellation notice, issued with a scheduled effective date of , is rescinded. This notice is being sent to the employer and to the Department of Consumer and Business Services. A copy of this notice was sent to the employer. Insurer representative signature: Date: Contact name and phone: ( ) 440-3217 (7/03/DCBS/WCD/WEB)
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