58-20-27. Application for self-insurance association--Form.
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/sd/title-58/chapter-58-20/58-20-27·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
An association proposing to self - insure its workers' compensation liability shall apply to the department for the authority to self - insure, using forms available from the department. The application shall include:
(1)The association's name;
(2)The location and mailing address of the association's principal office and where its books and records are kept;
(3)The name and address of each member of the association;
(4)A copy of the bylaws or plan of operation adopted by the association;
(5)Proof of compliance with § 58-20-28 ;
(6)A sample copy of the agreement between the association and the members securing the payment of each member's workers' compensation liability;
(7)A pro forma financial statement, on a form acceptable to the department, showing the financial ability of the association to pay the workers' compensation liability of its members; and
(8)The required application fee.