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Get PA LIBC-500 2009

Mpensation insurance company, third-party administrator (TPA), or person handling workers’ compensation claims for your company, are shown below. Employer Name: Date Posted: IF INSURED: (Complete all applicable spaces) IF SOMEONE OTHER THAN INSURER IS HANDLING CLAIMS: (Complete all applicable spaces) Name of Insurance Company: Name of TPA (Claims administrator): Address: PO Box 1558 Address: Zenith Insurance Company Sarasota, FL 34230-1558 Telephone Number: 1-800-440-5020 Telephone .

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