Get Ca Form A-2 2016-2025

Filling out the CA Form A-2 online for a Certificate of Consent to Self-Insure can be straightforward with the right guidance. This guide will walk you through each section of the form, ensuring that you complete it accurately and efficiently.

Follow the steps to successfully complete the CA Form A-2 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the legal name of the applicant as it appears in official documents. This is crucial for identification purposes.
3. Fill in the address of the applicant, including the street address, city, state, and zip code.
4. Provide the federal tax ID number of the group. This number is essential for tax and identification purposes.
5. Select the contact person's name, title, company name, address, phone number, and email address. Ensure accuracy so correspondence can be addressed correctly.
6. Indicate the type of public entity by checking the appropriate box to identify your organization.
7. Choose the type of application you are submitting by checking one of the provided boxes. This clarifies whether it is a new application or a reapplication.
8. Specify the date when the self-insurance program will commence. This is critical for compliance with regulations.
9. For current workers' compensation program, confirm whether you are currently insured or self-insured, providing the corresponding details.
10. Designate who will administer your agency's claims, providing their details if using a third-party administrator.
11. Indicate the total number of employees and public safety employees, ensuring that all information is filled out accurately.
12. Answer the questions regarding agency safety programs, including confirming the existence of an Injury and Illness Prevention Program.
13. Complete the certification section by signing and dating the form, ensuring it is authorized by an official representative of the agency.
14. Once all sections are completed, save any changes you have made, and proceed to download, print, or share the form as needed.

Complete your CA Form A-2 online today for a seamless submission process.