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Available Programs:

 Carrier Risk Tolerance:

Pay As You Go Workers' Compensation

All risks acceptable:  low, medium, and high.

Includes risks such as contractors, trucking, roofing, and temporary staffing.

Direct Bill Work Comp

All risks acceptable:  low, medium, and high.

Pay As You Go General Liability

Contractor and service risks acceptable:  low, medium, and high.

Commercial Packages- 12 Equal Installs

Non-construction risks only.

Workers Compensation Information:

 Owners Wages for Workers' Compensation

Individuals and Partners

Pending info.

LLC Members

Pending info.

Corporate Officers: Corporations

Pending info.

 General Liability Information:

 Owners Wages for General Liability:

Individuals and Partners

Pending info.

Corporate Officers & LLC Members

Pending info.

OR Resources & Links:

 OR Workers Compensation Forms:

State of Oregon

http://www.oregon.gov/

Department of Consumer & Business Services

http://egov.oregon.gov/DCBS/

350 Winter Street NE
Salem, Oregon 97301-3878
(503) 378-4100, Fax: (503) 378-6444

Workers’ Compensation Division

http://wcd.oregon.gov/

350 Winter Street NE, Room 27
Salem, Oregon 97301-3879
(800) 452-0288

(Workers’ Compensation Infoline); (503) 947-7810

Fax: (503) 947-7514; TTY: (503) 947-7993

Fraud Hotline: (800) 422-8778 (in Oregon)

Small Business Ombudsman: (503) 378-4209

Fax: (503) 373-7639

Ombudsman for Injured Workers: (800) 927-1271

Fax: (503) 373-7639

Workers’ Compensation Board

http://www.cbs.state.or.us/external/wcb/index.html

2601 25th Street SE, Suite 150
Salem, Oregon 97302-1282
(503) 378-3308

Workers’ Compensation Management-Labor Advisory Committee

http://www.oregon.gov/DCBS/MLAC/

Department of Consumer & Business Services
350 Winter Street, Room 200
Salem, Oregon 97301-3878
(503) 947-7867; Fax: (503) 378-6444

Ombudsman for Injured Workers

http://egov.oregon.gov/DCBS/OIW/index.shtml

350 Winter Street NE, Room 160
Salem, Oregon 97310
(800) 927-1271, (503) 378-3351

350 Winter Street NE
Salem, Oregon 97301-3878
(503) 378-4209, V/TTY: (503) 378-4100

SAIF Corporation

http://www.saif.com/

400 High Street SE
Salem, Oregon 97312-1000
(800) 285-8525, (503) 373-8000

Acord 130 Form

Certificate Request Form

ERM-14 Form

Order Loss Runs (Example)

NCCI Mod Authorization

* Information contained herein is based on the most accurate data as of the time of posting.  Please check with you states Division of Workers' Compensation Insurance for the most up to date information and to verify accuracy.