Workers' Compensation Insurance | Texas Mutual
[pic] P.O.Box 12058
Austin, TX 78711-2058
(512) 224-3800
Underwriting Department
(800) 859-5995
Fax (800) 359-0650
Dear Agent:
Section 406.097 of the Texas Labor Code affects coverage for sole proprietors, partners and corporate officers. It permits the insurance carrier to exercise the option whether or not to exclude executive officers that own less than 25%. Please advise the following information to assist us in our evaluation:
Name & Ownership% Distribution of Class Annual Covered/
Title Responsibilities Code Payroll Not Covered
Pres. __________________ ____ ____________ _____ ____________ _______
V. Pres. ________________ ____ ____________ _____ ____________ _______
V. Pres. ________________ ____ ____________ _____ ____________ _______
V. Pres. ________________ ____ ____________ _____ ____________ _______
Sec. __________________ ____ ____________ _____ ____________ _______
Treas. _________________ ____ ____________ _____ ____________ _______
This information needs to be maintained for our file, so that at the time of final audit there will not be incorrect charges. Please document any officer that is not active in Texas and those officers that are true Volunteers.
Thank you for your attention to this matter,
Underwriting Department
Texas Mutual Insurance Company
Rev. 04/05
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- termination for convenience
- workers compensation insurance texas mutual
- 79r4391 kla d texas
- final audit report center for state scholars ms word
- texas health and human services commission
- 2011generalprovisionssubrecipient redlined texas
- grant application certifications go texan
- comprehensive model fundraising agreement
- twc financial manual for grants and contracts texas
Related searches
- ny workers compensation law
- workers compensation new york website
- new york workers compensation board
- workers compensation ny rules
- nys workers compensation board
- workers compensation new york guidelines
- workers compensation by state compar
- workers compensation laws
- york insurance workers compensation claims
- workers compensation insurance board california
- florida workers compensation insurance requirements
- workers compensation insurance colorado