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Acord 130 Workers Comp Application.pdf

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Preview of Acord 130 Workers Comp Application

🔗 Source: viacompinc.com

📊 Size: 72 KB

📄 Pages: 4 pages

⬇️ Downloads: 257

Summary

This is a workers' compensation application form, specifically ACORD 130 (2013/09), which is used to gather information about a business and its operations to determine workers' compensation insurance premiums. The form requests various details, including business ownership, location, industry classification, employee information, and prior claims history. It also includes questions about the business's safety practices, use of subcontractors, and other relevant factors that may impact insurance rates. The form is divided into several sections, including policy information, employer's liability, and state-specific rating information. Additionally, the form includes warnings about the consequences of providing false information on the application, which may result in criminal and civil penalties in various states.

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Description

This is a workers' compensation application form, specifically ACORD 130 (2013/09), which is used to gather information about a business and its operations to...

Technical Information

File Format: PDF
File Size: 72 KB
Pages: 4
Language: EN
Total Downloads: 257
Last Updated: 3 days ago

Document Overview

This PDF document about Acord 130 Workers Comp Application provides comprehensive information and guidance. Whether you're a beginner or advanced user, this resource offers valuable insights into Acord 130 Workers Comp Application.