California Code of Regulations
Title 8 - Industrial Relations
Division 1 - Department of Industrial Relations
Chapter 8 - Office of the Director
Subchapter 2 - Administration of Self-Insurance Plans
Article 2 - Certificate of Consent to Self-Insure
Section 15203.3 - Resolution to Authorize Self-Insurance for an Individual Private Employer

Universal Citation: 8 CA Code of Regs 15203.3

Current through Register 2024 Notice Reg. No. 38, September 20, 2024

(a) The Corporate Resolution to authorize self-insurance of workers' compensation (Form A-5 (1-2016)) required pursuant to Section 15203(c) of these regulations as part of the application for a certificate to self-insure by any individual private employer shall be adopted by the private employer's Board of Directors or the general partners of an applicant partnership or joint venture, or owner of an applicant sole proprietorship. The resolution to authorize self-insurance shall include the following:

(1) A statement identifying the applicant by corporate or other legal name, the state of registration, and the date that the resolution was adopted;

(2) Identification by title of appointed officers or other company employees authorized to sign the application, execute any and all documents required for the application, and do subsequent acts required to maintain self-insurance approval.

(b) If an individual private self-insurer reincorporates, merges, or changes its identity, a new resolution shall be submitted to the Chief within 30 days of the change. The resolution shall confirm and authorize the maintenance of the self-insurer's responsibility under the successor's identity. The Chief may extend the period of time to submit the resolution for good cause.

(c) The Chief shall provide a model Corporate Resolution (Form A-5 (1-2016)) as part of the application form and will provide a model resolution for a non-corporate entity upon request.

1. New section filed 11-21-78; effective thirtieth day thereafter (Register 78, No. 47).
2. Amendment filed 1-19-79; effective thirtieth day thereafter (Register 79, No. 3).
3. Amendment of section heading and text filed 12-22-92; operative 1-21-93 (Register 93, No. 2).
4. Amendment of section heading and text filed 6-30-94; operative 6-30-94 (Register 94, No. 26).
5. Amendment of section heading and section filed 3-2-2009; operative 3-2-2009 pursuant to Government Code section 11343.4 (Register 2009, No. 10).
6. Amendment of section heading and section filed 12-14-2016; operative 1-1-2017 pursuant to Government Code section 11343.4(b)(3) (Register 2016, No. 51).

Note: Authority cited: Sections 54, 55 and 3702.10, Labor Code. Reference: Sections 59, 3700, 3701, 3702 and 3702.10, Labor Code.

Disclaimer: These regulations may not be the most recent version. California may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.