Get Form 07-6130 - Alaska Department Of Labor And Workforce ... - Labor State Ak

Filling out the Form 07-6130 is an important process for employers seeking to renew their Certificate of Self-Insurance in Alaska. This guide will provide you with clear, step-by-step instructions to ensure proper completion of the form online.

Follow the steps to fill out the Form 07-6130 correctly.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by entering the legal name of the Alaskan employer in the designated field. Ensure accuracy to avoid delays in processing.
3. Provide the mailing address of the Alaskan employer carefully, as this will be used for official correspondence.
4. Complete the section for the person responsible for the self-insured program. Include their name, title, mailing address, telephone number, fax number, and email address.
5. Detail the past year’s compensation experience in Alaska. Fill out information about the reporting year, number of Alaskan employees, total payroll, and claims history, including all relevant figures.
6. Acknowledge that an independent actuary’s report is required once every three years. This report must be accompanied by a letter from a company officer confirming that reserves are adequately accounted for.
7. If applicable, provide the details of the required security deposit, ensuring it meets the specified criteria according to the amount necessary based on outstanding liabilities.
8. Supply a description of the proposed excess insurance coverage, including the name of the carrier, types of coverages, and policy limits.
9. List the name and address of the Alaskan employer's adjuster who handles claims in the State of Alaska.
10. Compile all necessary documents required with the application, such as the audited financial statements, list of subsidiaries, security deposit (if applicable), and actuary report (if necessary).
11. Review all provided information for accuracy and completeness, then proceed to sign the application, acknowledging the signature of the authorized person and the notary's confirmation.
12. Final steps include saving changes to the form, downloading, printing, or sharing the completed application as needed.

Complete your renewal for the Certificate of Self-Insurance online today.