Self Insurance Templates

This form is used for applying for a self-insured construction wrap-up program in Ohio. It is specifically designed for construction projects in which multiple contractors are involved and a single insurance policy covers the liability for all parties. This application helps the construction company apply for self-insured status and provides details about the project and the contractors involved.

This form is used for applying for reimbursement of self-insured claims by Sysco in Ohio.

This document is a checklist for Risk Retention Groups operating in Oklahoma. It outlines the requirements and steps that need to be followed by Risk Retention Groups in order to comply with the state regulations.

This form is used for applying for a Group Self Insurance Association Permit in Oklahoma. It allows groups to self-insure for certain types of coverage.

This Form is used for applying for self-insurance in the state of Vermont. Self-insurance allows individuals or organizations to provide their own insurance coverage instead of purchasing it from an insurance company.

This form is used for applying for self-insurance in Vermont. It is for individuals or organizations who want to become self-insured instead of purchasing insurance from an insurance company.

This Form is used for self-insured individuals in Vermont to obtain a bond for workers' compensation insurance.

This form is used for self-insured employers in Washington to certify their excess insurance coverage.

This form is used for self-insurers in Washington to secure existing liabilities through a bond.

This form is used for providing a summary of vocational services under Option 2 self-insurance in Washington state.

This form is used for renewing the certificate of self-insurance in Alaska.

This Form is used for the self-insurer's annual report for calendar year in New York.

This form is used for employers in Louisiana to apply for the privilege of paying workers' compensation benefits to their employees as a self-insurer.

This Form is used for applying to take the self insurance administrator's examination in California.

This form is used for notifying the contract between a third-party administrator and a self-insurer in New Hampshire.

This Form is used for self-insurers in New York to apply for a Certificate of Excess Insurance Contract. It verifies that the self-insurer has excess insurance coverage in place to cover any claims that exceed their self-insured amounts.

This form is used for applying for a license to represent insurers and self-insurers in New York.

This Form is used for self-insured professional employer organizations (PEOs) in Ohio to notify their clients about the client relationship.

This form is used for a self-insurance agreement in Rhode Island. It is a document that allows individuals or entities to self-insure instead of relying on traditional insurance coverage.

This form is used for applying for a motor carrier permit in California when seeking a certificate of self insurance.

This form is used for assigning a deposit motor carrier permit certificate of self-insurance in California.

This form is used for applying as a self-insured construction project in Ohio.

This form is used for reporting self-insured injuries in the state of Arizona. It provides a way for individuals to document and report any injuries they have sustained while under a self-insured insurance plan.

This document is used for applying for a Certificate of Self Insurance in Rhode Island.

This document is used for understanding the assumption of self-insurance obligations in the state of South Dakota.

This type of document is a surety bond used for self-insurance in South Dakota.

This Form is used for obtaining a self-insurance aggregate surety bond in the state of Utah.

This form is used for applying for self-insurance in Utah. It is an official document that allows individuals or businesses to demonstrate their ability to cover potential losses or accidents without purchasing traditional insurance policies.

This Form is used for the renewal application of self-insurance in Utah.

This form is used for notifying the state of Texas about the election to self-insure for workers' compensation.

This form is used for political subdivisions in Texas to certify their self-insurance for workers' compensation, general liability, and/or motor vehicle liability insurance.