 |
 |
Membership Application
In order to provide the fastest turnaround and best service to you and your client, please feel free to use the following checklist to make sure that all the information and addenda needed to submit a complete application is included when applying for coverage.
- Materials can be sent via fax or e-mail
- Complete name of insured
- All DBAs and subsidiaries must be listed
- Current addresses and phone numbers for the insured and all DBAs and subsidiaries
- Check the appropriate box under the named insured (Corporation, Partnership, LLC or Individual)
- All partners or officers should be listed on the application as either included or excluded.
- Please give a contact name and phone number for loss control and audit purposes.
- NCCI code and Federal Employment ID number
- Proposed effective date
- Five years of historical payroll
- Large loss detail over $50,000
- Certified net-worth with CPA/bookkeeper signature, or the most recent available financial statement*
- Five years of loss runs
- KRF application, if not already a member
- Estimated annual payroll by job classification
*Financial information provided by applicants is kept in the strictest of confidence.
For membership information and an application, please download the regular membership form or associate membership form
and return it to the address provided.
|
 |
|
