California Workers Compensation Officer Exclusion Form
Excluding officers directors general partners etc. Or if you have employees including home improvement salespersons his. Https Www Cityofpalmdesert Org Home Showpublisheddocument Id 27110 Company representatives may not sign on behalf of the individual. California workers compensation officer exclusion form . These changes apply to new and renewal ca policy with effective dates of july 1 2018 or later. Under the insured s workers compensation policy with the above referenced insurer if an employment related injury occurs. The qualifier is a responsible managing employee rme. California labor code sections 3351 and 3352 governs the exclusion of these individuals. California application for exclusion of officers and stockholders owners and officers of corporations should complete this form to exclude themselves from a work comp policy. A qualifying officer or member of the board of directors of a quasi public or private corporation who owns at least 10 of the issued and outs