Model Corporate Resolution CORPORATE RESOLUTION AUTHORIZING APPLICATION TO THE DIRECTOR OF INDUSTRIAL RELATIONS, STATE OF CALIFORNIA FOR A CERTIFICATE OF CONSENT TO SELF INSURE WORKERS’ COMPENSATION LIABILITIES At a meeting of the Board of Directors of , (enter name of corporation) a corporation organized and existing under the laws of the State of held on the , day of 20 , a quorum being present, the following Resolution was adopted: RESOLVED that the (enter titles of authorized corporate officers) be and they are hereby severally authorized and empowered to make application for a Certificate of Consent to Self Insure to the Department of Industrial Relations of the State of California, and to execute any and all documents required for such application, including the Instrument of Undertaking in furnishing security. I, , the undersigned Secretary of the said , a corporation, hereby certify that I am the Secretary of said corporation, that the foregoing is a full, true and correct copy of the resolution duly passed by the Board of Directors thereof at a meeting of said Board held on the day and at the place therein specified, and that said resolution has never been revoked, rescinded, or set aside, and is now in full force and effect. IN WITNESS WHEREOF: I HAVE HEREUNTO SET MY HAND AND THE CORPORATE SEAL OF SAID CORPORATION THIS DAY OF 20 (SEAL) Secretary 2002 © American LegalNet, Inc. .