Laserfiche WebLink
NOV 06, 1989 93-01V-933 <br /> 'i STATE FARM <br /> WORKERS COMP n <br /> INSURANCE <br /> U S TECHNICAL ENVIRONMENTAL n } <br /> CONSULTING INC <br /> r 1414 W BROADWAY STE 150 <br /> TEMPE AZ 85282-1122 '!'STATE FARM FIRE AND CASUALTY COMPANY <br /> 1665 W ALAMEDA DR <br /> TEMPE AZ 85289-0001 <br /> Dear Policyholder, <br /> State Farm welcomes the opportunity to service your Workers' Compensation insurance <br /> needs. The following important information outlines claims, subcontractors and <br /> premium audit requirements. <br /> WORKERS' COMPENSATION CLAIMS <br /> 1. ALL ACCIDENTS ARE TO BE REPORTED IMMEDIATELY.' State authorities can impose <br /> penalties if a claim is submitted late. A Chaim Package has been mailed to you <br /> and provides complete instructions. Please read it carefully as it outlines <br /> compliance with the law. <br /> j 2. Employees must report any injury to you immediately. Prompt medical attention i <br /> should be obtained and report the injury to. us as quickly as possible. <br /> i <br /> SUBCONTRACTORS <br /> Your subcontractors are also required to comply with the Workers' Compensation laws <br /> and are to furnish you with a Workers Compensation policy's certificate of insurance. <br /> The subcontractors' insurance company will furnish it upon request. By having these <br /> certificates you will not have the subcontractors. payroll and cost added to your <br /> payroll and thereby increase your premium. However, any subcontractor who is being <br /> paid as <br /> an employee must have all remuneration in in your payroll. <br /> PREMIUM ADJUSTMENT DUE TO AN AUDIT <br /> In compliance with the policy conditions, the enclosed Workers' Compensation <br /> insurance policy is subject to an audit adjustment. This adjustment will be made on <br /> an annual basis unless otherwise indicated ,on the front of your policy. After <br /> f expiration you will either receive a refund or a bill for additional premium based on <br /> the information provided on the audit. All audit's are to be signed by you or an <br /> authorized representative acknowledging accuracy ,and completeness. <br /> In addition, if your audit adjustment reflects a 'substantial change in your operations <br /> or remuneration paid, an adjustment may be necessary to your current term policy. Any <br /> additional or return premium as a result of endorsing your current term policy will be <br /> billed or refunded to you or if applicable, your ,Monthly Pay Plan account. <br /> If you begin operations in another state or if your business operations are changed <br /> in any way, please notify your State Farm Agent. <br /> 'r <br /> Sincerely, <br /> ROBERT A LEMME <br /> COMMERCIAL OPERATIONS SUPT <br /> CC: MYERS, STEVE 1271/66 <br /> (F0025E) 10189 <br />