Workers’ Compensation

Name*
Address*
Street Address City State ZIP Code
Phone
Email
Proposed Effective Date:*
Current Carrier*
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
Class Code
Apt/Condo Complex Operation
9011 – Estimated Annual Payroll
Apt/Condo Complex Operation
8810 – Estimated Annual Payroll
Clerical Only
8740 – Estimated Annual Payroll
Apt/Condo Complex Operation
9015 – Estimated Annual Payroll
Building Operations
8742 – Estimated Annual Payroll
Outside Sales
*10% safety discount for all CAA Members plus other applicable CAA discounts available
Experience Modification Rate?
How many locations:*
(you may provide a list)
Would you like to provide a list of locations?*
- Yes
- No
Locations*
Phone*
Fax
Email
Federal I.D. #*
# of Years in Business*
Please choose one:*
- Corporation
- Limited Liability Company
- Sole Proprietor
- Partnership
Loss Information
No losses in past 5 years*
- Yes, I do not have any losses in the past 5 years
- No, I do have losses in the past five years
**Forward 5 years currently dated loss runs with application
File Upload*
Accepted file types: jpg, gif, png, pdf.
Please upload all documents related to the losses for the last five years.
Officers/Partners
Name % of Ownership Included/Excluded (Yes or No)

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Kevin, I don't say this often, but from the second we began this relationship you have been nothing but a wealth of knowledge and a tremendous help. I cannot thank you enough for being so flexible with us. Thank you again!
– Jeff P. — Menlo Park, CA

Dear Ms. Moss, I want to personally thank you for your timely and very professional response. You are very thorough AND you provide examples and attachments how to find solutions and how to address the issues effectively. What you did would have taken me hours of research and still I wouldn't feel as confident in my ability because I am not up to date on how certain areas of a contract are practiced.

I was wary about joining CAA but after today I know I did the right thing and plan on continuing my membership for a long time.

Many thanks
– Ravi K. — Folsom, CA

Andrea was very helpful and thorough. She provided different points and angles to my question for my consideration. In her questions she revealed that we need to revamp our internal paperwork and provided references from CAA's forms. I was very satisfied and felt confident in the decisions our company needs to make regarding the matter we sought with CAA. Thank you CAA. We appreciate your help.

I would describe CAA as my "Best Friend" in this venture called LANDLORDING. So happy you are there!
– Marsha W. — Fresno, CA

Thank you. You guys conducted a great campaign with Measure C. We would have obviously lost without your management, coordination, and hard work. Sure glad you guys are here...
– Rich B. — San Rafael, CA

I just want to say Thank You Team at CAA. Being a Landlord in California is frightening enough -- but with you, not as scary! I just know someone on the team understands!
– Kristi B. — Lewiston, CA

We have been a CAA members since 1984. CAA has provided us the guidance needed to successfully manage our property. The rental forms keep us on solid legal ground which has minimized our management workload and helped us maintain quality housing for our clients. Your weekly e-news keeps us appraised of property management issues to be on the lookout for. Your work in the California State legislature in Sacramento has provided valuable representation for our industry. Keep up the excellent work!
– Forrest L. — Ridgecrest, CA

We could not have accomplished the defeat of Measure C without CAA. We have been CAA members for over 30 years and membership fees have been returned to us “100 fold” with protection of our rental owner rights and the defeat of rent control in Santa Rosa. We at Pine Creek and Goodwin Property Management thank CAA for always supporting us.
– Patty G. — Santa Rosa, CA

I recently needed to take a few hours of classes to complete my Recertification as a CAA California Certified Residential Manager. I found it very convenient to do this through on demand classes at my office. The classes are well done and gave great education to further my property management skills. I even registered my maintenance team to listen to some of the classes. It benefitted us all. Thank you CAA!
– Beverly C. — Berkeley, CA

I recently needed to take a few hours of classes to complete my Recertification as a CAA California Certified Residential Manager. I found it very convenient to do this through on demand classes at my office. The classes are well done and gave great education to further my property management skills. I even registered my maintenance team to listen to some of the classes. It benefited us all.
– Beverly C. — Berkeley, CA

Name	% of Ownership	Included/Excluded (Yes or No)

Workers’ Compensation

Part 1

Part 2

Rating Information

Loss Information