Workers' Compensation Application-Step2

SELF RATER (Call Randy Foster For Rates (800) 936-7837)

Class Code Description Annual Payroll Rate Contribution
8810 Clerical

 

   
8748 Sales      
8391 Technicians      
8742 Parts & Service Writers      
Annual Contribution Before Experience Mod:  
Experience Modification Factor  
Annual Contribution After Experience Mod:  

This provisional indication is not an offer to bind coverage.  it is intended to provide a prospective member with a contribution estimate only.  ad comp falls under the jurisdiction of the California director of the department of industrial relations.  as such has the exclusive authority, subject to the regulation, to grant and/or revoke certificate of consent to self-insure.  the regulations also stipulate that ad comp shall have a board of trustees responsible for all operations of ad comp, including the responsibility to approve the request of any proposed member to join ad comp.

all prospective members must provide the required underwriting information to complete a formal application. click on "Quote"  for underwriting requirements.

FOR ASSISTANCE CALL RANDY FOSTER (800) 936-7837

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