California

Effective 7/1/18

AmTrust CA Corporate Officers & Directors Sample Waiver Form

AmTrust CA Partners & LLC Sample Waiver Form

EMPLOYERS CA Officer Exclusion Form

GUARD CA Cooperative Corporation Exclusion Form

GUARD CA General Partners and LLC Managing Members Exclusion Form

GUARD CA Officers or Directors Exclusion Form

GUARD CA Professional Corporation Exclusion Form

GUARD CA Trusts Exclusion Form

Hanover Exclusion Form 7.1.18

Hartford Officer Waiver Form

Markel CA Officer-Director Waiver of Coverage 7.1.18

Markel CA Partner-LLC Waiver of Coverage 7.1.18

Travelers CA LLC and Partnership Exclusion Form

Travelers CA Officer Exclusion Form

Current Forms

Hartford – Corporate Officers & Directors Waiver

Hartford – General Partners & LLC Managing Members Waiver

Employers Corporate Officer Exclusion Form

Employers Partner and LLC Exclusion Form

Travelers CA Partnership LLC Officer Exclusion form January 2017

Travelers CA Corp Officer Exclusion form January 2017 (002)

Guard CA Partnership Exclusion Form

Guard CA Limited Liability Exclusion Form

Guard CA Officers or Directors Exclusion Form

State Fund – LLCs Exclusion Form

State Fund – Partnerships Exclusion Form

State Fund – Corporations Exclusion Form

Preferred Employers Waiver of Coverage Form – Corporations

Preferred Employers Waiver of Coverage Form – Partners & LLC

FirstComp CA Officer – Director Waiver of Coverage

FirstComp CA Partner – LLC Waiver of Coverage

AmTrust Corporate Officers & Directors – Waiver of Coverage

AmTrust General Partners & LLC Managing Members – Waiver of Coverage

Everest WC LLC Partner Waiver Form

Everest WC Corp Waiver Form

CNA Corporate Officer and Directors Waiver

CNA Partnership or LLC Waiver