Free Oregon Self Insured Employer Forms

25 Forms found in Oregon — Self Insured Employer — Workers Comp — Page 1 of 1
Title Last Updated
Indemnity Agreement By Parent Corporation For Wholly-Majority Owned Subsidary July 17, 2018
Endorsement To Include Legal Entity In Self-Insured Certification July 17, 2018
Application For Self Insurance December 28, 2016
Workers Compensation Payroll And Assessment Quarterly Report Retrospective Rating Plan October 1, 2014
Workers Compensation Payroll And Assessment Quarterly Report Retrospective Rating Plan (5-12) October 1, 2014
Workers Compensation Payroll And Assessment Quarterly Report Normal Plan October 1, 2014
Workers Compensation Payroll And Assessment Quarterly Report Normal Plan (5-12) October 1, 2014
Self Insurer Report Of Losses Non Experience Rating Period October 1, 2014
Self Insurer Report Of Losses Experience Rating Period October 1, 2014
Group Self Insured Indemnity Agreement October 1, 2014
Exemption Provision Waiver October 1, 2014
Endorsement To Self Insured Group Application October 1, 2014
Claims Reserved In Excess Of Self-Insured Retention October 1, 2014
Application To Become A Self Insured Employer Group-Private Employers October 1, 2014
Application To Become A Self Insured Employer Group-Governmental Subdivisions September 30, 2014
Surety Bond April 7, 2011
Claim Reserve Worksheet February 11, 2009
Workers Compensation Payroll And Assessment Quarterly Report Normal Plan (5-06) December 20, 2006
Workers Compensation Payroll And Assessment Quarterly Report Retrospective Rating Plan (5-06) December 20, 2006
Irrevocable Standby Letter Of Credit November 3, 2006
Irrevocable Standby Letter Of Credit October 20, 2006
Security Agreement And Notice To Intermediary May 11, 2006
Memorandum Of Understanding (Alternative Type Of Security Deposit) May 11, 2006
Surety Rider May 11, 2006
Irrevocable Standby Letter Of Credit May 6, 2005