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  1. Workers' Disability Compensation Group Self-Insurer Application ... [PDF]

    ... the terms, and provisions of the Indemnity Agreement and/or Amendments thereto filed
    or ... conform to the terms of the agreements the Group may enter into with ...

    http://www.michigan.gov/documents/wca_402_group_packet_88212_7.pdf - Text Version
  2. EMPLOYERS APPLICATION FOR SELF INSURANCE [PDF]

    ... parent company___________________________ (Subsidiaries must have separate applications
    and indemnity agreements) 12. If foreign corporation, give address of ...

    http://dir.alabama.gov/docs/forms/wc_app_self_insur.pdf - Text Version
  3. FJD Notice to the Bar [PDF]

    ... partners, members), or liability or indemnity of managers (officers, directors,
    managers ... of incorporation, by-laws or agreements governing such enterprises; 2 ...

    http://courts.phila.gov/pdf/forms/civil/civil-cover-sheet.pdf - Text Version
  4. Rights & Obligations under the Nebraska Workers' Compensation ... [PDF]

    ... resolve their disputes and reach agreements. To request informal dispute resolution ... of
    compensation (either medical or indemnity payments) made, or the claim ...

    http://www.wcc.ne.gov/publications/rightsobligations_information_sheet.pdf
  5. Illinois Workers' Compensation Act [PDF]

    ... and financial statement, or security, indemnity or bond, or amount of ... of the Commission.
    Deposits under escrow agreements shall be cash, negotiable United ...

    http://www.iwcc.il.gov/act.pdf - Text Version
  6. Page 1 of 3 OKLAHOMA WORKERS' COMPENSATION COURT 1915 NORTH ... [PDF]

    ... claims) Year $ Medical Paid $ Indemnity Paid $ Total Paid ... the applicant to the agreements
    contained herein) __________________________________________________ ...

    http://www.owcc.state.ok.us/CourtForms/Current/Form%201B.pdf - Text Version
  7. Instructions for One Year Request for Certification.qxd [PDF]

    ... and agrees to honor designated provider agreements. b. Provider communicates with
    the ... This includes medical costs, indemnity costs, and miscellaneous expenses ...

    http://www.coworkforce.com/DWC/FormsDeskAids/PDF/one_year_request_for_certification.pdf
  8. Occupational Injury & Illness Incidence Rates [PDF]

    ... claims, including both medical and indemnity payments. Each claim in the ... levels specified
    in collective bargaining agreements, government programs and private ...

    http://www.dol.ks.gov/WC/html/2006AnnualRptAppendix.pdf - Text Version
  9. NEW JERSEY DIVISION OF PURCHASE AND PROPERTY WAIVERED ... [PDF]

    ... specifically provided in the Contract. H. INDEMNITY/LIABILITY TO THIRD PARTIES: 1)
    The ... due or coming due under other agreements between the Contractor and the ...

    http://www.nj.gov/treasury/purchase/forms/wtermss.pdf - Text Version
  10. State of New Jersey [PDF]

    ... does the surety company rely on the indemnity of any individual(s) or any ... a copy
    of lending covenants and agreements). Amount of Amount Termination Name and ...

    http://www.state.nj.us/treasury/dpmc/Assets/Files/dpmc-27_05.pdf - Text Version
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