Form A-6 Agreement And Undertaking For Security Deposit {A-6}

Form A-6 - AGREEMENT AND UNDERTAKING FOR SECURITY DEPOSIT. This form is used by California employers applying for or holding a Certificate of Consent to Self-Insure workers’ compensation liabilities. Issued by the Department of Industrial Relations, Office of Self-Insurance Plans. It documents the employer’s agreement to post and maintain a security deposit to guarantee payment of workers’ compensation benefits as required under Labor Code sections 3700–3705. By signing the agreement, the employer authorizes the State of California to hold the security deposit in trust and grants the Director of Industrial Relations authority to collect, use, or liquidate the deposit if the employer defaults on compensation obligations. Interest on the deposit is generally remitted to the employer when no default exists. www.FormsWorkflow.com