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Indemnity And Guaranty Agreement Form. This is a Kansas form and can be use in Workers Compensation.
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Tags: Indemnity And Guaranty Agreement, K-WC-132, Kansas Workers Compensation,
INDEMNITY AND GUARANTY AGREEMENT K-WC 132 (Rev. 6-12) KANSAS DEPARTMENT OF LABOR www.dol.ks.gov Page 1 of 3 For value received for the purpose of enabling ____________________________________ to be a (name of subsidiary company) self-insured employer, the following named parent company being ___________________________ (name of parent company) ________________________ does hereby guarantee the Kansas workers compensation obligations of its above named subsidiary. That by this agreement the above named parent corporation does hereby guarantee to the Kansas Division of Workers Compensation that said parent corporation will meet all obligations of the said subsidiary under the Kansas Workers Compensation Act. That said parent corporation, by this agreement, guarantees payment of all past, existing, future and potential obligations of the subsidiary for temporary and permanent compensation, medical benefits, death benefits, court costs, assessments and any other liability or assessment required or imposed on the subsidiary by the Kansas Workers Compensation Act. In the event an application for hearing is filed with the Kansas Division of Workers Compensation naming said subsidiary as the employer, the parent corporation named herein does hereby agree that they can be named as a party in lieu of said subsidiary by an Administrative Law Judge, the Director, or an appeal court, the parent corporation does hereby agree to pay all compensation awarded in the same manner as the subsidiary would have been obligated to pay said compensation. The parent corporation shall have a right to cancel and terminate this agreement at any time upon giving the subsidiary and the Division of Workers Compensation at least 60 DAYS written notice of its desire to do so. Such cancellation however, shall not affect the parent corporation's obligations under this guarantee agreement up through the date of cancellation. That upon cancellation of this indemnity agreement the self insurance status heretofore given to the subsidiary by the Division of Workers Compensation, which approval was expressly conditioned on the continued existence of this indemnity agreement, may be revoked without further notification by the Kansas Division of Workers Compensation. That any attorney's fees incurred by the Division of Workers Compensation in enforcing this agreement shall be paid by the parent corporation. This agreement shall be effective as of 12:01 a.m. _____________________________, 20______. DIVISION OF WORKERS COMPENSATION 401 SW Topeka Blvd., Suite 2, Topeka, KS 66603-3105 · Phone (785) 296-4000 · wcselfinsurance@dol.ks.gov American LegalNet, Inc. www.FormsWorkFlow.com Kansas Department of Labor K-WC 132 (Rev. 6-12) Indemnity and Guaranty Agreement Page 2 of 3 Signed, sealed and delivered this __________ day of _______________________, 20____. ______________________________________________________ Name of Parent Corporation BY:___________________________________________________ Signature of President ______________________________________________________ Typed name ATTEST: ______________________________________________________ Secretary Corporate Seal This agreement must be accompanied by a resolution of the Board of Directors authorizing this guaranty agreement. DIVISION OF WORKERS COMPENSATION 401 SW Topeka Blvd., Suite 2, Topeka, KS 66603-3105 · Phone (785) 296-4000 · wcselfinsurance@dol.ks.gov American LegalNet, Inc. www.FormsWorkFlow.com Kansas Department of Labor K-WC 132 (Rev. 6-12) Indemnity and Guaranty Agreement Page 3 of 3 Parent Corporation:___________________________________________________ CONSENT OF THE BOARD OF DIRECTORS Date:_______________________ Pursuant to the authority contained in the Statutes of the State of ______________________, the undersigned, being all of the members of the Board of Directors of __________________ _____________________ Corporation, (state) _________________________Corporation, do hereby adopt the following resolutions with the same force and effect as though adopted at a meeting of said Board of Directors duly called and held: WHEREAS, it is in the best interest of the corporation that the __________________ be a self-insurer under the Kansas Workers Compensation Act; and WHEREAS, the State of Kansas requires that the Corporation guarantee the Kansas workers compensation obligations of the ___________________________________ (subsidiary) NOW, THEREFORE, IT IS RESOLVED, that the Corporation guarantee the Kansas workers compensation obligations of the _________________________________________________ (subsidiary) and RESOLVED FURTHER, that the officers of the Corporation be, and they hereby are, authorized and empowered in the name of and on behalf of the Corporation, to execute and deliver the indemnity and guaranty agreement and any other documents necessary to guarantee the Kansas workers compensation obligations of the __________________________________________________. (subsidiary) IN WITNESS WHEREOF, the undersigned have hereunto set their hands effective this __________________ day of ___________________________, 20_____. CORPORATE SEAL: DIVISION OF WORKERS COMPENSATION 401 SW Topeka Blvd., Suite 2, Topeka, KS 66603-3105 · Phone (785) 296-4000 · wcselfinsurance@dol.ks.gov American LegalNet, Inc. www.FormsWorkFlow.com