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

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§15205. Interim Certificates.

(a) The Chief 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 Chief within 180 days of the effective date of the Interim Certificate.
(b) To qualify for an Interim Certificate, the existing private individual self-insurer must demonstrate the following:
(1) Compliance with the requirements of Section 15203.2;
(2) The private self-insurer holding the Master Certificate of Consent to Self-Insure has furnished proof satisfactory to the Chief of financial responsibility and ability to guarantee the payment of any compensation due; and
(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 Chief 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.
HISTORY
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 Code section 11343.4 (Register 2009, No. 10).
4. Amendment of subsections (a), (b)(1)-(2) and (c) filed 12-14-2016; operative 1-1-2017 pursuant to Government Code section 11343.4(b)(3) (Register 2016, No. 51).


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