The following information is required 
to obtain board approval

1. A completed acord workers compensation application.
   

2. A completed Auto Dealers Compensation Of California, Inc. (AD COMP) New member application supplement.
   

3. four year's prior loss experience Valued within 90 days of proposed membership effective date.
   

4. employee concentration form.
   

5. financial statements - dealer operating statements FOR 2007, 2008 AND 2009 YEAR-TO-DATE.
   

6. experience modification worksheet for period last published by the wcirb OR COPY OF COMPLINE EXPERIENCE MOD HISTORY.
   

the following information is required for request for certificate of consent to self insure

(State Approval)

1. completed joinder and indemnification agreement.