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(a) The Manager may issue an Interim Certificate of Consent to Self Insure to a subsidiary or affiliate of an existing private self insurer. The Interim Certificate of Consent to Self Insure will be issued for a period not to exceed 180-days. An application for a permanent Certificate to Self Insure as set forth in Section 15203 and the application filing fees as set forth in Section 15204 just be submitted within 90 days of issuance of an interim certificate.
(b) To qualify for an Interim Certificate, the existing private self insurer must demonstrate the following:
(1) Net worth on the last financial report filed with the Manager of Self Insurance Plans, pursuant to Section 15203.2, that shows at least $10 million in net worth,
(2) The private self insurer holding the Master Certificate of Consent to Self Insure has furnished proof satisfactory to the Manager of financial responsibility and ability to guarantee the payment of any compensation due.
(3) The subsidiary or affiliate being added to the self insurance program does not represent more than 50% of the annual payroll of the existing self insurer as reported on the most recent Self Insurers' Annual Report.
(c) A request for an Interim Certificate shall be made by the existing private self insurer in writing to the Manager and provide the following information on each subsidiary or affiliate new to the self insurance program:
(1) The full legal name, state of incorporation, and Federal Tax Identification Number;
(2) The requested effective date of the Interim Certificate;
(3) The annual payroll of the subsidiary or affiliate during the last 12 months; or, the latest 12-month period for which payroll figures are available and what 12 month period is being reported.
(4) A statement that the Master Certificate holder shall be financially responsible to pay all workers' compensation claims arising out of the period of time its subsidiary or affiliate is granted an Interim Certificate;
NOTE: The Manager shall prepare a model letter that will contain all the necessary information to permit the private self insurer to request issuance of an Interim Certificate. The Manager shall provide this model letter to the self insurer upon request.
(d) Upon receipt of a written request for an Interim Certificate from a private self insurer meeting the requirements set forth in Section 15205(b) and (c), the Manager shall issue the Interim Certificate within 14 days.
(1) An applicant for an interim certificate will be notified in writing within 14 days if the application is incomplete and what specific information is required.
(e) To qualify for a permanent Certificate of Consent to Self Insure, the master self insurer will be required to comply with the requirements in Article 2 of these regulations, including submittal of application forms and filing fees as specified in subsection (a).
NOTE: Sections 54, 55 and 3702.10, Labor Code. Reference: Sections 59, 3700, 3702.5 and 3702.10, Labor Code.
HISTORY
1. New section filed 2-26-97; operative 3-28-97 (Register 97, No. 9).
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