Form A-5 Corporate Resolution Authorizing Application {A-5}

Form A-5 - CORPORATE RESOLUTION AUTHORIZING APPLICATION TO THE DIRECTOR OF INDUSTRIAL RELATIONS, STATE OF CALIFORNIA FOR A CERTIFICATE OF CONSENT TO SELF-INSURE WORKERS’ COMPENSATION LIABILITIES. This form is used by California employers seeking approval to self-insure their workers’ compensation liabilities. Issued by the California Department of Industrial Relations, this form documents a formal resolution adopted by a corporation’s board of directors authorizing the company to apply for a Certificate of Consent to Self-Insure. The resolution confirms that the corporation has approved the application and authorizes any designated corporate officer to execute and submit all required documents on the corporation’s behalf. A certification section completed by the corporate secretary verifies that the resolution was duly adopted and remains in effect. www.FormsWorkflow.com