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Part 1

Workers’ Compensation Insurance (Coverage A and C)

Statutory Coverage as provided by the following states: California

Coverage includes Medical, Rehabilitation and Loss of Income Benefits for injuries arising out of a work related injury.

Part 2

Employers Liability Insurance (Coverage B)

Limits of Insurance
Bodily Injury By Accident – $1,000,000 Each Accident
Bodily Injury By Disease – $1,000,000 Policy Limit
Bodily Injury By Disease – $1,000,000 Each Employee

Rating Information

Apt/Condo Complex Operation
Apt/Condo Complex Operation
Clerical Only
Apt/Condo Complex Operation
Building Operations
Outside Sales
*10% safety discount for all CAA Members plus other applicable CAA discounts available
(you may provide a list)
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Loss Information

No losses in past 5 years*
**Forward 5 years currently dated loss runs with application
Officers/Partners
Name
% of Ownership
Included/Excluded (Yes or No)
 
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