Skip to main content
California Apartment Association
Search
Go
Join Now
Member Login
Navigation menu
Key topics
Beginning the tenancy
Fair housing
Move-in process
Rental agreements/leases
Application and screening
Section 8
Security deposits
During the tenancy
AB 1482: Statewide rent cap
Entering the unit
Fair housing
Maintenance and repairs
Pets and assistive animals
Rent collection and payment
Rent control
Rent increases
Price gouging
Ending the tenancy
Ellis Act
Eviction
Eviction moratoria
“Just cause” for eviction
Terminating the tenancy
Walkthrough process
All topics
Forms & Compliance
Education
Advocacy
Insurance
News
Resources
COVID-19 Resources
Insurance
Helpline
Upcoming Events
Publications
Industry Directory
Property Management Directory
Resident Screening
For Renters
Political Action Fund
VoterVoice
Bill Tracking
CAA Board of Directors
Website Navigation Videos
Major Cities
Los Angeles
San Diego
San Jose
San Francisco
Fresno
Sacramento
Long Beach
Oakland
Other cities
Workers’ Compensation Insurance
Name
*
Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Email
Proposed Effective Date:
*
MM slash DD slash YYYY
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, Max. file size: 64 MB.
Please upload all documents related to the losses for the last five years.
Officers/Partners
Name
% of Ownership
Included/Excluded (Yes or No)
Δ