Laserfiche WebLink
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 00 04 <br />(Ed. 7-98) <br />EXTENSION OF INFORMATION PAGE <br />Schedule of Forms <br />111I:10Ti[tIN <br />POLICYNO, ORWC311495 <br />Form Numbers AmAcable States <br />WC 000422A - TERR RISK INS PROG REAUTHORIZATION ACT <br />WC 000421C - CATASTROPHE(OTHER THAN CERT ACTS OF TERR <br />WC 040422 - CALIFORNIA SHORT -RATE CANCELLATION END'T <br />* WC 040002 - CA EXT OF INFO PAGE-SCH OF NAMED INSURED <br />* WC 040004 - CA EXT OF INFO PAGE -SCHEDULE OF FORMS <br />WC 040301.13 - POLICY AMENDATORY ENDORSEMENT-CALIFORNIA <br />WC 040310 - CA DUTY TO DEFEND <br />WC 040410 - CA ESTIMATED ANNUAL PREMIUM ENDORSEMENT <br />* WC 040601A - CA CANCELLATION ENDORSEMENT <br />PN 0499025 - CA POLICYHOLDER NOTICE - WC RATING LAWS <br />PN 049901D - CA YOUR RIGHT TO RATING AND DIVIDEND INFO <br />PN 049904 - CA INS. GUARANTEE ASSOC,(CIGA) SURCHARGE <br />WC 000001A - INFORMATION PAGE <br />WC 000000E - STANDARD POLICY <br />* As earl: of GUARD's ongoing commitment to environmental responsibility throughout our operations, we have <br />chosen not to reprint those forms (marked with an asterisk) that have not changed and were previously sent to <br />you. You can obtain a new copy of any of these forms by accessing your account information at GUARD's <br />Policyholder Service Center (a selection available via our web site atwww.guard.com). Please be aware that <br />you will be asked to enter your policy number, policy inception date, and federal ID number in order to log on to <br />this secure portion of our site. <br />Alternatively, you can contact us via phone at 1.800.673-2465; our Customer Service Representatives will <br />either be able to help you locate a document yourself or can send a copy to your. As always, we thank you for <br />selecting GUARD as your insurer. We look Forward to serving you! <br />INTERNAL use - xx Page - 3 - Information Page <br />MGA :ORWC311495 WC 000001A <br />Date :09/08/2012 <br />16 South River Street- P.O. Box A-H • Wilkes-Barre, PA 18703-0020• www.guard.com <br />