California Event Matrix - CWCI

Employer FEIN should not equal Insurer FEIN unless self-insured. 18 Employer Name 19 Employer Address Line 1 20 Employer Address Line 2 21 Employer City 22 Employer State 23 Employer Postal Code Must be a valid US Postal code. 24 Self Insured Indicator 25 Industry Code See Section N for reporting guidelines on industry code. ................
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