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Chapter 8. Office of the Director
Subchapter 2. Administration of Self-Insurance Plans
Article 2. Certificate to Self Insure

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§15205. Interim Certificates.

(a) The Manager may issue an Interim Certificate of Consent to Self Insure to a subsidiary or affiliate of an existing private individual self insurer or an existing public agency self insurer. The Interim Certificate of Consent to Self Insure will be issued for a period not to exceed 180 days. A Certificate of Consent to Self Insure to replace the Interim Certificate shall not be issued unless a completed application and accompanying documents required by Section 15203 and the application fee required by Section 15204 are submitted to the Manager within 180 days of the effective date of the Interim Certificate. However, the Manager may extend the Interim Certificate for an additional period of up to 90 days upon a showing of cause by the Interim Self Insurer.

(b) To qualify for an Interim Certificate, the existing private individual 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 insured as reported on the most recent Self Insurers' Annual Report.  

(c) A request for an Interim Certificate shall be made by the existing public agency or individual 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) Documentation of the total annual payroll of the subsidiary or affiliate during the last 12 months and of the dates for which the payroll information represents or for the latest 12-month period for which payroll figures are available.  

  (4) A statement that the Master Certificate holder shall be financially responsible for payment of all workers' compensation claims arising out of the period of time its subsidiary or affiliate is granted an Interim Certificate.  

     Note: Authority cited: Sections 54, 55 and 3702.10, Labor Code. Reference: Sections 59, 3700, 3702.5 and 3702.10, Labor Code.  

1. New section filed 2-26-97; operative 3-28-97 (Register 97, No. 9).

2. Amendment of subsection (e) filed 6-4-98; operative 7-4-98 (Register 98,  No. 23).

3. Amendment filed 3-2-2009; operative 3-2-2009 pursuant to  Government Codesection 11343.4 (Register 2009, No. 10).

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