Rules and Regulations of the State of Georgia
 

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If you are an entitled government entity pursuant the Georgia Administrative Procedures Act, <a target="_new" href="http://links.casemakerlegal.com/states/GA/books/Code_of_Georgia/browse?ci=25id=gasos&amp;codesec=50-13-7&amp;title=50&amp;#50-13-7(d)">O.C.G.A.§ 50-13-7(d)</a> contact the State of Georgia's Administrative Procedures Division at 678-364-3785 to enable these features for your location.)</p> <p>To access this website, you must agree to the following: </p> <p> These terms of use are a contract between you and/or your employer (if any), and Lawriter, LLC. </p> <p> You agree that you will not copy, print, or download anything from this website for any commercial use. </p> <p> You agree not to use any web crawler, scraper, or other robot or automated program or device to obtain data from the website.</p> <p> You agree that you will not sell, will not license, and will not otherwise make available in exchange for anything of value, anything that you download, print, or copy from this site.</p> <p> You agree that you will not copy, print, or download any portion of the regulations posted on this site exceeding a single chapter of regulations for sale, license, or other transfer to a third party, except that you may quote a reasonable portion of the regulations in the course of rendering professional advice.</p> <p> If you violate this agreement, or if you access or use this website in violation of this agreement, you agree that Lawriter will suffer damages of at least $20,000. </p> <p> THIS WEBSITE AND ITS CONTENT ARE PROVIDED "AS IS." 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If you are an entitled government entity pursuant the Georgia Administrative Procedures Act, <a target="_new" href="http://links.casemakerlegal.com/states/GA/books/Code_of_Georgia/browse?ci=25id=gasos&amp;codesec=50-13-7&amp;title=50&amp;#50-13-7(d)">O.C.G.A.§ 50-13-7(d)</a> contact the State of Georgia's Administrative Procedures Division at 678-364-3785 to enable these features for your location.)</p> <p>To access this website, you must agree to the following: </p> <p> These terms of use are a contract between you and/or your employer (if any), and Lawriter, LLC. </p> <p> You agree not to use any web crawler, scraper, or other robot or automated program or device to obtain data from the website. </p> <p> You agree that you will not sell or license anything that you download, print, or copy from this website.</p> <p> THIS WEBSITE AND ITS CONTENT ARE PROVIDED "AS IS." 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Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-174&amp;title=34#" target="_newtab">34-9-174</a>.</P> <h2><a href="/GAC/120-2-34-.02" name="120-2-34-.02" title="120-2-34-.02">Rule 120-2-34-.02 Purpose</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.02(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> To provide for the establishment and regulation of Group Self- Insurance Funds by which Workers' Compensation Insurance benefits may be provided for employees of certain qualified associations or groups.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.02(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> To protect the interests of the members of a Fund and those employees thereof that are provided Workers' Compensation benefits thereunder.</td> </tr> </table> <h2><a href="/GAC/120-2-34-.03" name="120-2-34-.03" title="120-2-34-.03">Rule 120-2-34-.03 Definitions</a></h2> <P>All terms defined in O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-150&amp;title=34&amp;getbrowsepage=yes#" target="_newtab">34-9-150</a><I>et seq.</I>, hereinafter referred to as the "Group Self-Insurance Funds Act" or "Act", which are used in this Regulation shall have the same meaning as in the Act.</P> <h2><a href="/GAC/120-2-34-.04" name="120-2-34-.04" title="120-2-34-.04">Rule 120-2-34-.04 Notice of Intent to Form a Fund</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.04(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> At least thirty (30) days prior to forming a Group Self-Insurance Fund or signing the Intrastate Agreement, applicants shall first file with the Commissioner a "Notice of Intent to Form a Self- Insured Fund," referred to as form GSF-IN. The GSF-IN shall comply with O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-151.1&amp;title=34#" target="_newtab">34-9-151.1</a> and must contain: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.04(1)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The name of the group forming the Fund;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.04(1)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The name of the proposed administrator;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.04(1)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The type or types of employers to be offered membership into the Fund;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.04(1)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A statement that the group is knowledgeable of and will comply with the requirements of Article 5 of Chapter 9 of Title 34 of the Official Code of Georgia Annotated and this regulation; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.04(1)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A copy of the intrastate agreement that will be used to establish the Fund.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.04(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Commissioner shall have thirty (30) days to review the "Notice of Intent to Form a Self-Insured Fund" and shall render a decision to accept or reject the proposed Fund within thirty (30) days of filing. If the Commissioner approves the Notice, or does not respond within a thirty (30) day period, the filing is deemed accepted and the Fund may begin recruiting new members and may file an application for a Certificate of Authority. Approval of the Notice does not equate to approval of an application for issuance of a Certificate of Authority.</td> </tr> </table> <h2><a href="/GAC/120-2-34-.05" name="120-2-34-.05" title="120-2-34-.05">Rule 120-2-34-.05 Application for Certificate of Authority</a></h2> <P>Each application for an original Certificate of Authority shall be made on Form GSF-1, entitled "Application for Certificate of Authority for Group Self-Insurance Fund." The application must be accompanied by all stipulated documents including, but not limited to: GSF-1, GSF-5, GSF-6, GSF-7 and GSF-11 as well as the required, non-refundable filing fee specified in O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-8-1&amp;title=33#" target="_newtab">33-8-1</a> and adhere to the following conditions:</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.05(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Conditional on acceptance of the Fund under previous section.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.05(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Commissioner's decision on "Notice of Intent" is not binding on the "Certificate of Authority."</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.05(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The application must be submitted within ninety (90) days of the first signed intrastate agreement.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.05(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the application is not filed within six (6) months of the acceptance of the "Notice of Intent," the Commissioner's acceptance of the "Notice of Intent" is withdrawn.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.05(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Commissioner has ninety (90) days, from the date the application is received, to accept or reject the application.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.05(f)">(f)</a></td> <td valign="top" style="text-align:left" class="leftalign"> No application for a Certificate of Authority shall be deemed complete until all information requested, whether of any member, trustee or administrator of the Fund, or of the Fund itself, is provided to the Commissioner.</td> </tr> </table> <h2><a href="/GAC/120-2-34-.06" name="120-2-34-.06" title="120-2-34-.06">Rule 120-2-34-.06 Renewal of Certificate of Authority</a></h2> <P>Each application for renewal of a Certificate of Authority shall be made on or before the first day of March of each year on Form GSF-2 entitled "Application for Renewal of Certificate of Authority for Group Self- Insurance Fund." It shall be accompanied by all stipulated documents, including the annual statement, and a renewal fee as specified in O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-8-1&amp;title=33#33-8-1(1)(CC)" target="_newtab">33-8-1(1)(CC)</a>. The Certificate of Authority issued pursuant to this chapter shall continue in full force and effect until specifically refused or revoked by the Commissioner in accordance with O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-169&amp;title=34#" target="_newtab">34-9-169</a>.</P> <h2><a href="/GAC/120-2-34-.07" name="120-2-34-.07" title="120-2-34-.07">Rule 120-2-34-.07 Application for Membership to a Fund</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.07(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Each application for a Certificate of Authority shall be accompanied, for each member of the Fund, by a separate Form GSF-3 or a comparable form containing the same information as the GSF-3, entitled "Application for Membership in Group Self-Insurance Fund."</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.07(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> After the Fund has been granted a Certificate of Authority, it may add new members in the following manner: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.07(2)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> By submitting underwriting criteria to the Department in accordance with O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-155&amp;title=34#" target="_newtab">34-9-155</a> and having the criteria approved by the Department; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.07(2)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> By submitting a Form GSF-3 fifteen (15) days prior to the effective date of coverage; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.07(2)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For Funds that have a potential member which does not meet their approved underwriting criteria, they may submit a GSF-3 and ask for specific approval of the new member.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.07(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Any new member application submitted on or after the proposed effective date of coverage will automatically be rejected for lack of timely submission.</td> </tr> </table> <h2><a href="/GAC/120-2-34-.08" name="120-2-34-.08" title="120-2-34-.08">Rule 120-2-34-.08 Termination of Membership</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.08(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A Fund may submit Termination Criteria to the Commissioner for approval. The criteria should stipulate reasons for terminating the relationship between the Fund and the member including, but not limited to, non-payment of premium, claims experience, and failure to report claims.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.08(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A member electing to terminate its participation in the Fund shall submit to the Fund and to the Commissioner a Form GSF-4 entitled "Application for Termination of Membership in Group Self-Insurance Fund" at least ninety (90) days prior to the requested date of termination. If the Fund has an approved Termination Criteria in place, the member may submit a letter terminating its participation at least thirty (30) days prior to the requested date of termination.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.08(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> As a prerequisite to approval of termination of membership in the Fund, a member must demonstrate to the Commissioner, and to the Trustees, that it will, after termination, comply with its duty as an employer under O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-1&amp;title=34#" target="_newtab">34-9-1</a> through § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-134&amp;title=34#" target="_newtab">34-9-134</a>.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.08(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Except where termination criteria has been approved, within ten (10) days of receipt of the application for termination of membership, the Fund shall notify the Commissioner of the applicant's current standing, and state any reasons why the application should not be approved.</td> </tr> </table> <h2><a href="/GAC/120-2-34-.09" name="120-2-34-.09" title="120-2-34-.09">Rule 120-2-34-.09 Application to Serve as Officer, Director or Trustee</a></h2> <P>Each prospective officer, director or trustee of a Fund shall submit to the Fund and to the Commissioner a Form GSF-5, entitled "Application to Serve as Officer, Director or Trustee of Group Self-Insurance Fund".</P> <h2><a href="/GAC/120-2-34-.10" name="120-2-34-.10" title="120-2-34-.10">Rule 120-2-34-.10 Application to Serve as Administrator</a></h2> <P>Each prospective administrator of a Fund shall submit to the Fund and to the Commissioner a Form GSF-6, entitled "Application to Serve as Administrator of Group Self-Insurance Fund".</P> <h2><a href="/GAC/120-2-34-.11" name="120-2-34-.11" title="120-2-34-.11">Rule 120-2-34-.11 Execution of Intrastate Agreement</a></h2> <P>The following requirements must be met for the Intrastate Agreement to be properly executed:</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.11(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The member must sign the signature page, or resolution if a government entity, certifying that: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.11(a)1.">1.</a></td> <td valign="top" style="text-align:left" class="leftalign"> The member subscribes to and abides by the Intrastate Agreement: the entire document does not have to be signed;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.11(a)2.">2.</a></td> <td valign="top" style="text-align:left" class="leftalign"> The member has received a copy of the Intrastate Agreement;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.11(a)3.">3.</a></td> <td valign="top" style="text-align:left" class="leftalign"> The member is aware of joint and several liability.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.11(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A copy of the signed Intrastate Agreement shall be provided to the member.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.11(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> After approval by the Commissioner, amendments to the Intrastate Agreement only become effective after providing written notice to all members.</td> </tr> </table> <h2><a href="/GAC/120-2-34-.12" name="120-2-34-.12" title="120-2-34-.12">Rule 120-2-34-.12 Request for Additional Information</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.12(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Commissioner may, in connection with any filing required by § <a title="120-2-34" href="120-2-34">120-2-34</a>, submit a written request to the Fund for additional information needed to complete the review of the filing.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.12(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> No filing shall be deemed complete until all such requested information is provided to the Commissioner.</td> </tr> </table> <h2><a href="/GAC/120-2-34-.13" name="120-2-34-.13" title="120-2-34-.13">Rule 120-2-34-.13 Financial Reporting: Annual and Quarterly Statements</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.13(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> On or before the first day of March, each Fund shall file with the Commissioner financial statements on forms approved by the Commissioner. These forms shall relate to the financial condition of the Fund as of December 31st of the preceding calendar year.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.13(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Unless otherwise exempted by the Commissioner, on or before the fifteenth (15) day of May, August and November, each Fund shall file a quarterly statement on forms approved by the Commissioner.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.13(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Only forms approved by the Commissioner will be accepted as financial statements for the Funds. All other forms used will be returned to the Fund.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.13(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Funds operating on a fiscal year, versus a calendar year, shall annually file a financial statement on or before the first day of March and quarterly statements on or before the fifteenth (15th) of May, August, and November. Each statement shall reflect the appropriate complete reporting period of either 3, 6, 9, or 12 months.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.13(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Upon written request from a Fund, and payment of the necessary fee as specified by O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-8-1&amp;title=33#" target="_newtab">33-8-1</a>, the Commissioner may allow for an amended or updated filing of an annual or quarterly statement and such statement shall then be substituted for the original filing.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.13(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Pursuant to O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-8-1&amp;title=33#33-8-1(6)(W)" target="_newtab">33-8-1(6)(W)</a>, a per day late fee will apply to late filings.</td> </tr> </table> <h2><a href="/GAC/120-2-34-.14" name="120-2-34-.14" title="120-2-34-.14">Rule 120-2-34-.14 Books and Records: Examination</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.14(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Commissioner or his representative may, either before granting a Certificate of Authority or at any time thereafter, at least once every five (5) years, examine the Fund. The examination will include all affairs that relate to the business of operating a Fund. All fund-related accounts, books, publications, records and vouchers shall be held for a term of at least five (5) years and maintained at the principal address shown on its Certificate of Authority. All materials pertaining to an active claim for which benefits are being paid shall be maintained until the claim is settled or otherwise terminated and then held for one year after the file is closed or until such file has been subject to an Insurance Department examination, whichever period is longer.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.14(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Commissioner or his representative shall have free access to all fund-related accounts, records, books, publications and vouchers. The administrators, officers, trustees, employees and representatives of the Fund shall aid the Commissioner or his representative, as far as it is in their power, in making the examination.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.14(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If, at any time, the Commissioner finds the records or accounts to be inadequate or incorrectly kept or posted, he may employ experts to rewrite, post or balance such records at the expense of the Fund being examined if the Fund has failed to correct such records or accounts within sixty (60) days after the Commissioner has given it notice to do so.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.14(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The costs of any examination performed by the Commissioner, or his designated representative under this section, shall be borne by the Fund being examined, in accordance with O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-2-15&amp;title=33#" target="_newtab">33-2-15</a>.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.14(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The examination report shall be processed in accordance with O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-2-14&amp;title=33#" target="_newtab">33-2-14</a>.</td> </tr> </table> <h2><a href="/GAC/120-2-34-.15" name="120-2-34-.15" title="120-2-34-.15">Rule 120-2-34-.15 Security Deposit</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.15(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Each Fund granted a Certificate of Authority by the Commissioner shall be required to establish and maintain a security deposit as set forth in O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-161&amp;title=34#" target="_newtab">34-9-161</a>.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.15(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Any surety bond pledged as security deposit must be on a form approved by the Commissioner.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.15(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> When a security deposit is pledged in cash or eligible securities, the agreement with the bank or institution must be reviewed and approved by the Commissioner prior to the pledge of the security deposit.</td> </tr> </table> <h2><a href="/GAC/120-2-34-.16" name="120-2-34-.16" title="120-2-34-.16">Rule 120-2-34-.16 Specific and Aggregate Excess Insurance Program</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.16(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Fund shall maintain a specific and aggregate excess loss funding program acceptable to the Commissioner.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.16(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A Fund shall submit a plan for funding excess losses which, in the opinion of the Commissioner, provides for stability and protection to the Fund members. Any subsequent changes relating to coverages, terms and/or conditions of coverage, including loss fund and retention level, shall be submitted to the Commissioner for approval shall be submitted thirty (30) days prior to their expected use. The Commissioner shall approve or disapprove submitted plans within thirty (30) days of receipt. If the Commissioner fails to approve or disapprove such plan within thirty (30) days, a Fund may use such plan. However, the Commissioner may require a Fund to resubmit the Fund's excess loss funding plan upon written request to the Fund or the Fund's administrator of record. Upon request, a Fund shall resubmit their excess loss funding program to the Commissioner for approval.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.16(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Fund may submit a plan which has been developed or reviewed by an actuary who is a Member of the Casualty Actuarial Society and a Member of the American Academy of Actuaries. Plans developed or reviewed by actuaries may utilize alternative funding techniques including pledging of a Fund's unobligated surplus, spread loss programs or other programs which, in the opinion of the actuary, shall not unduly jeopardize the Fund's stability.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.16(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Any plan submitted by a Fund to the Commissioner for approval of an excess loss funding program which is not supported by detailed actuarial analysis by an actuary who is a Member of the Casualty Actuarial Society and a Member of the American Academy of Actuaries shall include: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.16(4)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Specific Excess insurance with minimum coverage limits of $2,000,000 per occurrence or in such greater limits as may be required by the Commissioner in order to assure stability of the Fund; and,</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.16(4)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Aggregate Excess Insurance with minimum annual aggregate coverage limits of $1,000,000 or such greater limits as may be required by the Commissioner; and,</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.16(4)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An attachment point for the Specific Excess Insurance of no greater than $350,000 per occurrence. A Fund may apply for such higher attachment points that, in the opinion of the Commissioner, will not unduly jeopardize the Fund's stability. If a higher attachment point is requested, the application shall be made 30 days in advance of the intended change but does not mandate that such change be effectuated. And,</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.16(4)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An attachment point for the Aggregate Excess Insurance no greater than the Fund's normal annual premium plus investment income less the Fund's administrative expenses. A Fund may apply for a higher attachment point for the Aggregate Excess Insurance that, in the opinion of the Commissioner, will not unduly jeopardize the Fund's stability. If a higher attachment point is requested, the application shall be made 30 days in advance of the intended change but does not mandate that such change be effectuated.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.16(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Any policy of insurance written for the benefit of a Fund in accordance with this rule shall contain the following: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.16(5)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A provision that cancellation or termination of the policy is not effective except upon sixty (60) days written notice by certified or registered mail to the Fund and to the Commissioner; and,</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.16(5)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A provision that the policy shall be automatically renewed at the expiration of the policy period except upon sixty (60) days by written certified or registered mail to the Fund and to the Commissioner; and,</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.16(5)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A statement by the aggregate excess insurer that the excess insurance coverage limits and retention are not subject to any side agreements or the increases or decreases other than as set forth in the Fund's application for approval of their excess loss funding program; and,</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.16(5)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A statement that the policy does not exclude or restrict coverages due to the insolvency or bankruptcy of the Fund or any of its members.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.16(5)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Such policy shall not contain any restrictions which would relieve the insurer of its duties and liabilities due to any administrative action taken by the Commissioner.</td> </tr> </table> </td> </tr> </table> <h2><a href="/GAC/120-2-34-.17" name="120-2-34-.17" title="120-2-34-.17">Rule 120-2-34-.17 Administrator's Bond and Errors and Omissions Coverage</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.17(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Each administrator shall have and maintain a fidelity bond in the amount of at least $100,000, as required by Rule <a title="120-2-49-.07" href="120-2-49-.07">120-2-49-.07</a>, on a form approved by the Commissioner.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.17(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Each administrator shall have and maintain errors and omissions coverage or other appropriate liability insurance, written by an insurer authorized to transact insurance in this State, in an amount of at least $100,000.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.17(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Any policy written in accordance with paragraph (2) of this Rule shall be for a term of at least one year and shall contain provisions that: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.17(3)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> cancellation or termination of the policy is not effective except upon sixty (60) days written notice by registered or certified mail;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.17(3)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the policy is automatically renewable at the expiration of the policy period except upon sixty (60) days written notice of either party; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.17(3)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> copies of notices required in subparagraphs (a) and (b) be mailed to the Commissioner by registered or certified mail.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.17(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Upon approval by the Commissioner, bonds or policies may be written by an eligible surplus lines insurer.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.17(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Compliance by the administrator with paragraphs (1) and (2) of this Rule is a prerequisite to approval of its application by the Commissioner.</td> </tr> </table> <h2><a href="/GAC/120-2-34-.18" name="120-2-34-.18" title="120-2-34-.18">Rule 120-2-34-.18 Compensation of Administrator or Trustee</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.18(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Each administrator, trustee or officer of the Fund, or any employee or agent of any or all of them, shall submit to the Commissioner a copy of any proposed contract entitling him or her to any direct or indirect compensation from the Fund for services performed or sales or purchases made to or for the Fund.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.18(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Commissioner shall determine whether the compensation is reasonable and equitable under the circumstances and consistent with the provisions of the laws of Georgia and this Regulation. The Commissioner may accept or reject the proposed contract. The trustee, officer or administrator, or any employee or agent of any or all of them, may withdraw his or her proposed contract prior to its effective date.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.18(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Any forms of direct or indirect compensation to a trustee, officer or administrator or to a corporation or firm in which a trustee, officer or administrator is in any way financially interested, other than that provided by this Regulation, O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-180&amp;title=34#34-9-180(c)" target="_newtab">34-9-180(c)</a>, or the Bylaws of the Fund, shall be a violation of the trustee, officer or administrator's fiduciary responsibility. In such event, the Commissioner may, in addition, suspend, revoke or refuse to renew the Certificate of Authority of the Fund.</td> </tr> </table> <h2><a href="/GAC/120-2-34-.19" name="120-2-34-.19" title="120-2-34-.19">Rule 120-2-34-.19 Rates and Premiums</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.19(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Fund shall obtain prior approval of the Commissioner for any proposed rate, rating plan, or rating rule to be used by the Fund to determine premium. The Fund shall make any proposed rate filing with the Commissioner thirty (30) days prior to the proposed effective date. The filing shall include all supporting data to justify the proposed rates or rating plan. The Commissioner may require an actuarial report certifying that the proposed rates are adequate, not excessive nor unfairly discriminatory.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.19(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Each charter and subsequent member of the Fund shall pay yearly premiums as outlined in the Intrastate Agreement or according to a plan approved by the Fund's Board of Trustees and the Commissioner. Payment plans will not be approved if they conflict with the Intrastate Agreement.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.19(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Any rate, rating plan, or rating rule filing shall include a letter from the excess carrier(s) stating they have acknowledged the proposed changes.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.19(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Fund shall obtain prior approval for any other assessment against any member that falls outside of subsection (1) above. The method used to determine the assessment shall also be submitted.</td> </tr> </table> <h2><a href="/GAC/120-2-34-.20" name="120-2-34-.20" title="120-2-34-.20">Rule 120-2-34-.20 Reserve Requirement</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.20(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Fund shall maintain loss reserves computed in the same manner and upon the same basis as required by O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-163&amp;title=34#34-9-163(1) and (2)" target="_newtab">34-9-163(1) and (2)</a>, and shall report these reserves in all financial reports filed with the Commissioner.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.20(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Annual Report shall include an actuarial opinon specifically stating that carried reserves: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.20(2)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> meet the requirements of O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-163&amp;title=34#34-9-163(1) and (2)" target="_newtab">34-9-163(1) and (2)</a>;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.20(2)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> are computed in accordance with accepted loss reserving standards and principles; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.20(2)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> make a reasonable provision for all unpaid loss and loss expense obligations of the Fund under the terms of its agreement.</td> </tr> </table> </td> </tr> </table> <h2><a href="/GAC/120-2-34-.21" name="120-2-34-.21" title="120-2-34-.21">Rule 120-2-34-.21 Dividends</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.21(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Dividends may be returned to the members of the Fund pursuant to O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-162&amp;title=34#34-9-162(d)" target="_newtab">34-9-162(d)</a>.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-34-.21(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A dividend shall not be paid out of a specific Fund year which would cause the Fund to show an overall negative surplus.</td> </tr> </table> <h2><a href="/GAC/120-2-34-.22" name="120-2-34-.22" title="120-2-34-.22">Rule 120-2-34-.22 Organization of a Fund</a></h2> <P>Bona fide members of trade associations and professional associations as well as groups of municipalities, counties, school boards and hospital authorities may extend workers' compensation benefits to their employees through group self-insurance programs, or "Funds". Any Fund may designate a person to act as an agent, pursuant to the Principal and Agent statutes in Chapter 6 of Title 10 of the Official Code of Georgia Annotated, on behalf of such group and assist in the organizational activities of the Fund, or to perform such other duties as are specified by such group.</P> <h2><a href="/GAC/120-2-34-.23" name="120-2-34-.23" title="120-2-34-.23">Rule 120-2-34-.23 Penalties</a></h2> <P>Any Fund administrator failing to comply with the requirements of this Regulation shall be subject to such penalties as prescribed in O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-173&amp;title=34#" target="_newtab">34-9-173</a> or § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-181&amp;title=34#" target="_newtab">34-9-181</a>. Furthermore, if the Commissioner has cause to believe that improper rates, classifications or experience modification factors are used, any Fund administrator will be subject to the penalties and related expenses set forth in O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-9-40.1&amp;title=33#33-9-40.1(c)(1),(2) and (3)" target="_newtab">33-9-40.1(c)(1),(2) and (3)</a>.</P> <h2><a href="/GAC/120-2-34-.24" name="120-2-34-.24" title="120-2-34-.24">Rule 120-2-34-.24 Severability</a></h2> <P>If any provision of this Regulation or the application thereof to any person or circumstance, is held invalid by a court of competent jurisdiction, the remainder of the Regulation or the applicability of such provision to other persons or circumstances shall not be affected.</P> <P>EXHIBIT A</P> <P>OFFICE OF</P> <P>COMMISSIONER OF INSURANCE</P> <P>WARREN D. EVANS</P> <P>COMMISSIONER OF INSURANCE</P> <P>SAFETY FIRE COMMISSIONER</P> <P>INDUSTRIAL LOAN COMMISSIONER</P> <P>COMPTROLLER GENERAL</P> <P> SEVENTH FLOOR, WEST TOWER</P> <P> FLOYD BUILDING</P> <P> 2 MARTIN LUTHER KING, JR. DRIVE</P> <P> ATLANTA, GEORGIA 30334</P> <P><B>APPLICATION FOR CERTIFICATE OF AUTHORITY</B></P> <P><B>FOR GROUP SELF-INSURANCE FUND</B></P> <P>To the Commissioner of Insurance, State of Georgia:</P> <P>Application is hereby made for a Certificate of Authority for Group</P> <P>Self-Insurance Fund.</P> <P>(If additional space is required to answer any question, use separate sheets of paper number each to correspond to the question being answered.)</P> <P>(1) Name of Fund _________________________________________________________</P> <P>(2) Address of principal office of Fund ___________________ </P> <P>_______________________________________________________________________</P> <P>(3) Location of Fund records _____________________________________________</P> <P>(4) Desired effective date of Fund _______________________________________</P> <P>(5) Address of principal office of association or group ___________ </P> <P>_______________________________________________________________________</P> <P>(6) Telephone number _____________________________________________________</P> <P>(7) Name of registered agent of Fund _____________________________________</P> <P>(8) Address of registered agent of Fund __________________________________</P> <P>(9) List the complete membership of the Fund and their addresses:</P> <P><U>Name</U><U>Address</U></P> <P>(10) How will the administrative obligations of the Fund be met? _______________________________________________________________________</P> <P>(11) Name and address of the administrator _______________________________</P> <P>(12) Is any officer or trustee of the Fund an owner, partner, officer, director, shareholder or employee of the administrator or any parent or affiliated company? ______________________________________________________</P> <P>If so, explain. __________________________________________________________</P> <P>(13) Name and address of designated depository ___________________________</P> <P>(14) Fund balance in depository as of application date ___________________</P> <P>(15) Other assets of Fund (describe) _____________________________________</P> <P>(16) Estimated amount of first year normal annual premium ________________</P> <P>(17) Estimated administrative costs, amount and percentage _______________</P> <P>(18) Estimated first year losses based on members' loss history of last three years ______________________________________________________________</P> <P>(19) Other liabilities of Fund (describe) ________________________________</P> <P>(20) Has each applicant for membership been informed that it will be jointly and severally liable for all liabilities of the Fund? </P> <P>_______ Yes _______ No</P> <P>THE FOLLOWING MUST ACCOMPANY THE APPLICATION:</P> <P>___________ A copy of the bylaws of the Fund</P> <P>___________ A copy of the intrastate agreement among the members</P> <P>___________ A copy of any agreement between the Fund and any contract administrator of the Fund</P> <P>___________ A copy of any contract, endorsement or application form the</P> <P>Fund intends to use</P> <P>___________ An "Application for Membership in Group Self-Insurance</P> <P>Fund" from each member of the Fund</P> <P>___________ An "Application to Serve as Officer, Director or Trustee of Group Self-Insurance Fund" from any officer, director or member of the board of trustees of the Fund</P> <P>___________ An "Application to Serve as Administrator of Group</P> <P>Self-Insurance Fund" from any administrator of the Fund</P> <P>In consideration of the approval of the application, the applicant agrees to the following:</P> <P>(A) That its trustees, officers, administrator and members will comply with all provisions of O.C.G.A. Chapter 34-9 , the Regulations promulgated thereunder, all lawful Orders of the Commissioner and the Rules and Order of the State Board of Workers' Compensation.</P> <P>(B) That it will admit as a new member any eligible applicant who complies with the requirements of O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-152&amp;title=34#34-9-152(h)" target="_newtab">34-9-152(h)</a> and the Regulations thereunder and will notify the Commissioner of its evaluation of each new applicant for membership.</P> <P>(C) That it will notify the Commissioner of the amount and method of determination of any proposed premium or other assessment to be paid by a member or members.</P> <P>(D) That it will notify the Commissioner of any dividend in accordance with Regulation.</P> <P>(E) That any and all books and records of the Fund will be made available for inspection and examination by the Commissioner or his representative.</P> <P>(F) That the Fund will deposit acceptable securities with the Commissioner in the amount equal to twenty-five percent (25%) of the normal annual premium (ten percent (10%) if the Fund consists of a group of municipalities, counties or school boards) or post surety bond in the form prescribed by the Commissioner in the amount equal to thirty-five percent (35%) of the normal annual premium (fifteen percent (15%) if the Fund consists of a group of municipalities, counties or school boards).</P> <P>(G) That it will obtain specific and aggregate excess insurance policies written by companies authorized or approved to transact insurance in this State in the amounts prescribed by Regulation or such other amounts as the Commissioner deems necessary, and that it will submit copies of these policies to the Commissioner.</P> <P>(H) That it will continuously maintain these policies and will, if it desires to make any change in these policies, notify the Commissioner at least sixty (60) days before the proposed effective date of the change.</P> <P>(I) That the Commissioner may, at any time, revoke, suspend or fail to renew this Certificate of Authority in accordance with O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-169&amp;title=34#" target="_newtab">34-9-169</a>.</P> <P>(J) THAT THE FUND WILL NOT GUARANTEE ANY FINANCIAL OBLIGATION OF ANY of its OFFICERS, TRUSTEES OR ADMINISTRATORS. ________ (Initial)</P> <P>(K) THAT NO OFFICER, TRUSTEE, ADMINISTRATOR, OR MEMBER OF ANY COMMITTEE OR EMPLOYEE OF THE FUND WHO IS CHARGED WITH THE DUTY OF INVESTING OR HANDLING THE FUND'S ASSETS WILL BORROW ANY ASSET OF THE FUND; DEPOSIT OR INVEST SUCH ASSETS EXCEPT IN THE NAME OF THE FUND; BE PECUNIARILY INTERESTED IN ANY LOAN, PLEDGE OF DEPOSIT, SECURITY, INVESTMENT, SALE, PURCHASE, EXCHANGE, REINSURANCE OR OTHER SIMILAR TRANSACTION OR PROPERTY OF THE FUND; OR TAKE OR RECEIVE FOR HIS OWN USE ANY FEE, BROKERAGE, COMMISSION, GIFT OR OTHER CONSIDERATION FOR OR ON ACCOUNT OF ANY SUCH TRANSACTION MADE BY OR ON BEHALF OF THE FUND, EXCEPT AS PROVIDED BY O.C.G.A. SECTION <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-180&amp;title=34#34-9-180(c)" target="_newtab">34-9-180(c)</a>OR BY REGULATION OF THE COMMISSIONER ______ (Initial)</P> <P>(L) That it will notify the Commissioner within fourteen (14) days of any change in any of the information contained in this application. </P> <P>_______________________________________________________________________</P> <P>(PRINT NAME OF FUND)</P> <P>BY:____________________</P> <P>_______________________</P> <P>(PRINT NAME)</P> <P>_______________________</P> <P>(PRINT TITLE)</P> <P>_______________________</P> <P>(DATE)</P> <P><U>AFFIDAVIT</U></P> <P>COUNTY___________</P> <P>STATE ___________</P> <P>I,__________________________________________________________, the undersigned being the _____________________________________________ of the</P> <P>(Title)</P> <P>__________________________________________________________________________</P> <P>(Name of Fund)</P> <P>swear (or affirm) that to the best of my knowledge and belief, the statements contained in the application, including the accompanying documents, are true and complete.</P> <P>By:_____________________</P> <P>Sworn before me this________________</P> <P>day of______________________, 19 ___</P> <P>____________________________________</P> <P>NOTARY PUBLIC</P> <P>My Commission Expires_______________</P> <P>EXHIBIT B</P> <P>OFFICE OF</P> <P>COMMISSIONER OF INSURANCE</P> <P><B>WARREN D. EVANS</B></P> <P>COMMISSIONER OF INSURANCE</P> <P>SAFETY FIRE COMMISSIONER</P> <P>INDUSTRIAL LOAN COMMISSIONER</P> <P>COMPTROLLER GENERAL</P> <P> SEVENTH FLOOR WEST TOWER</P> <P> FLOYD BUILDING</P> <P> 2 MARTIN LUTHER RING, JR. DRIVE</P> <P> ATLANTA, GEORGIA 30334</P> <P><B>APPLICATION FOR</B></P> <P><B>RENEWAL OF CERTIFICATE OF AUTHORITY</B></P> <P><B>FOR GROUP SELF-INSURANCE FUND</B></P> <P>To the Commissioner of Insurance, State of Georgia:</P> <P>_______________________________________________________________________</P> <P>(NAME OF FUND)</P> <P>_______________________________________________________________________</P> <P>(ADDRESS)</P> <P>hereby applies for the renewal of its Certificate of Authority for the year</P> <P>____________. In consideration for the approval of this application, the applicant agrees to all conditions contained in the original</P> <P>"Application for Certificate of Authority for Group Self-Insurance</P> <P>Fund." List any changes in the information contained in the Application for Certificate of Authority, as amended by subsequent applications for renewal. Use separate sheets of paper, numbering each to correspond to the question. List changes even if the Commissioner has been notified unless such changes were listed on the previous application for renewal.</P> <P>_______________________________________________________________________</P> <P>(PRINT NAME OF FUND)</P> <P>BY: _________________</P> <P>_____________________</P> <P>(PRINT NAME)</P> <P>_____________________</P> <P>(PRINT TITLE)</P> <P>_____________________</P> <P>(DATE)</P> <P><U>AFFIDAVIT</U></P> <P>COUNTY_____________</P> <P>STATE _____________</P> <P>I,_______________________________________________________, the undersigned being the__________________________________________________________ of the</P> <P>(Title)</P> <P>_______________________________________________________________________</P> <P>(Name of Fund)</P> <P>swear (or affirm) that to the best of my knowledge and belief; the statements contained in the application, including the accompanying documents, are true and complete.</P> <P>By:____________________</P> <P>Sworn before me this__________________</P> <P>day of______________________, 19______</P> <P>______________________________________</P> <P>NOTARY PUBLIC</P> <P>My Commission Expires_________________</P> <P>EXHIBIT C</P> <P>OFFICE OF</P> <P>COMMISSIONER OF INSURANCE</P> <P><B>WARREN D. EVANS</B></P> <P>COMMISSIONER OF INSURANCE</P> <P>SAFETY FIRE COMMISSIONER</P> <P>INDUSTRIAL LOAN COMMISSIONER</P> <P>COMPTROLLER GENERAL</P> <P> SEVENTH FLOOR WEST TOWER</P> <P> FLOYD BUILDING</P> <P> 2 MARTIN LUTHER RING, JR. DRIVE</P> <P> ATLANTA, GEORGIA 30334</P> <P><B>APPLICATION FOR MEMBERSHIP IN</B></P> <P><B>GROUP SELF-INSURANCE FUND</B></P> <P>All information pertaining to the application shall not be deemed to be a public document and shall be maintained in confidence by the Commissioner and the Fund.</P> <P>To the Commissioner of Insurance of the State of Georgia and the</P> <P>___________________________________________________________Fund.</P> <P>Application is hereby made for membership in above Fund.</P> <P>(1) Member Name ___________________________________________</P> <P>(2) Address _______________________________________________</P> <P>(3) Telephone Number ______________ Number of Employees____</P> <P>(4) Federal Employer I.D. Number __________________________</P> <P>(5) Nature of Business ____________________________________</P> <P>(6) Type of Business: () Corporate () Partnership () Individual </P> <P>() Other</P> <P>(7) List of Partners, Owners or Corporate Officers: </P> <P><U>NAME</U><U>ADDRESS</U><U>TITLE</U><U>PERCENTAGE OWNERSHIP</U></P> <P>(7a) List Chief Administrative Officer of a governmental or hospital entity: </P> <P>_______________________________________________________________________</P> <P>(8) If Corporation, name and address of Resident Agent____________________ </P> <P>_______________________________________________________________________</P> <P>(9) Locations of all operations to be included in the Fund: </P> <P><U>NAME</U><U>PRINCIPAL ADDRESS</U><U>TYPE OF BUSINESS</U></P> <P>(10) If applicant is a subsidiary, name parent company: </P> <P><U>NAME</U><U>ADDRESS</U><U>TYPE OF BUSINESS</U></P> <P>IF THE APPLICANT IS UNABLE TO OBTAIN ALL THE INFORMATION REQUESTED IN QUESTION (11) IT MAY, INSTEAD, INCLUDE A CERTIFICATION SIGNED BY THE ADMINISTRATOR OR CHAIRMAN OF THE BOARD OF TRUSTEES OF THE FUND THAT the information ACTUALLY PROVIDED IS SATISFACTORY TO THE FUND.</P> <P>(11) Loss history for last three completed years: </P> <P><U>Year Ending</U><U>Year Ending</U><U>Year Ending</U></P> <P>a. Number of accidents requiring medical attention only</P> <P> b. Number of accidents requiring lost time of more than 3 days </P> <P><U>Year Ending</U><U>Year Ending</U><U>Year Ending</U></P> <P>c. Total paid claims $ $ $</P> <P>d. Outstanding reserves $ $ $</P> <P>e. Total incurred losses $ $ $ </P> <P>(Paid and Reserves)</P> <P>f. Fatalities in the last three years: No_____ Yes_____ Number_____ </P> <P>If yes, explain.___________________________________________________</P> <P>___________________________________________________________________</P> <P>(12) Estimated premium for twelve month period </P> <P>Beginning: Month________ Day______ Year _______</P> <P>Classification Classification Estimated Current Estimated</P> <P>Code Description Annual Rate Annual</P> <P>Payroll Premium</P> <P>_____________________________________________________________________</P> <P>Total Payroll ____________________ Total Premium __________________</P> <P>(13) Present carrier of workers' compensation insurance or indicate if applicant participated in a workers' compensation self-insurance program: </P> <P>___________________________________________________________________</P> <P>(14) Present workers' compensation premium_________________________</P> <P>(15) Statement of Assets and Liabilities as of_____________________ </P> <P>(Date)</P> <P>APPLICANT MAY SUBMIT A COPY OF THE MOST RECENT AUDITED FINANCIAL STATEMENT CERTIFIED BY A CERTIFIED PUBLIC ACCOUNTANT, IN LIEU OF COMPLETING QUESTIONS (15) AND (16). QUESTIONS (15) AND (16) DO NOT HAVE TO BE ANSWERED BY MUNICIPALITY, COUNTY AND SCHOOL BOARD APPLICANTS.</P> <P>DOLLARS ONLY</P> <P>----------------------------------------------------------------------</P> <P><U>Current Assets:</U><U>Current Liabilities:</U></P> <P>Cash on hand ___________________ Accounts Payable __________________</P> <P>Cash in bank ___________________ Notes payable given for merchandise</P> <P>Notes receivable ___________________________________</P> <P>(Less than 1 year old) ________ Notes payable negotiated otherwise</P> <P>(not transferable) ____________ ___________________________________</P> <P>Merchandise_____________________ Other current liabilities and</P> <P>Other current assets: accruals:</P> <P>________________________________ ___________________________________</P> <P>________________________________ ___________________________________</P> <P>________________________________ ___________________________________</P> <P>________________________________ TOTAL CURRENT</P> <P>LIABILITIES _______________________</P> <P>TOTAL CURRENT ASSETS: __________ <U>Long-Term Debt:</U></P> <P><U>Fixed Assets:</U> Notes payable _____________________</P> <P>Machinery and fixtures _________ Bonded Indebtedness</P> <P>(net of depreciation) _________ Mortgage Indebtedness</P> <P>Real Estate Other long-term debts</P> <P>(net of depreciation)__________ TOTAL LONG-TERM DEBT</P> <P>Investment (describe nature TOTAL LIABILITIES</P> <P>of same) _______________________</P> <P>________________________________ <U>Surplus/Owner Equity:</U></P> <P>TOTAL FIXED ASSETS _____________ Capital Stock (Common)</P> <P>Other non-current assets Paid-in excess</P> <P>(describe)______________________ Retained Earnings</P> <P>________________________________ Undivided Profits</P> <P>________________________________ (Partnership only)</P> <P>________________________________ Other _____________________________</P> <P>___________________________________</P> <P>TOTAL SURPLUS/OWNER EQUITY</P> <P>___________________________________</P> <P>TOTAL LIABILITIES, SURPLUS/</P> <P>TOTAL ASSETS ___________________ OWNERS EQUITY______________________</P> <P>______________________________________________________________________</P> <P>______________________________________________________________________</P> <P>Contingent Liability - Notes Receivable of customers discounted or sold and not included in Assets ___________________________________________</P> <P>______________________________________________________________________</P> <P>Other Contingent Liabilities__________________________________________</P> <P>______________________________________________________________________</P> <P>If a limited partnership, give date of formation and duration ________</P> <P>______________________________________________________________________</P> <P>STATEMENT - Is it based on actual inventory?__________________________</P> <P>If so, date. ________________________</P> <P>VERIFICATION - Have the books been audited by a certified public accountant? __________ If so, give date of audit. _____________</P> <P>If applicant is a corporation: Authorized capital stock</P> <P>(Common) $_________________________ (Preferred) $_____________________ </P> <P>Paid and subscribed as follows:</P> <P>Cash ________________________________________ $_______________________</P> <P>Patents, Trademarks _________________________ $_______________________</P> <P>Goodwill ____________________________________ $_______________________</P> <P>Property listed among Assets ________________ $_______________________</P> <P>(16) Relate facts, covering the past three years: </P> <P>Sales Expenses Payroll Profits</P> <P>Inc. Payroll) </P> <P>Year 19__________________________________________________________________</P> <P>Year 19__________________________________________________________________</P> <P>Year 19__________________________________________________________________</P> <P>Amount of indebtedness past due ____________________ $ _______________</P> <P>Insurance of merchandise ___________________________ $ _______________</P> <P>Insurance on buildings and plant ___________________ $ _______________</P> <P>(17) Safety, sanitation and welfare conditions: </P> <P>Is your business or any part thereof inspected otherwise than by State</P> <P>Authority? ____________ If so, by whom? _________________________________</P> <P>Have you fulfilled all safety requirements of the State Board of Workers'</P> <P>Compensation?__________________</P> <P>Have you a committee of safety whose duty it is to recommend safety devices and to secure compliance with statutes or general orders of the</P> <P>Board of Workers' Compensation as to safety and sanitation?______________</P> <P>Do you maintain a hospital in connection with your works?_________________</P> <P>If so, state description of its equipment and service.____________________</P> <P>_______________________________________________________________________</P> <P>_______________________________________________________________________</P> <P>In consideration for the approval of this application, the applicant agrees as follows:</P> <P>(A) That the applicant will comply with O.C.G.A. Chapter 34-9 , the </P> <P>Regulations promulgated thereunder, all lawful Orders of the Commissioner, the Rules and Orders of the State Board of Workers' Compensation, and the rules, regulations and bylaws of this Fund.</P> <P>(B) That the applicant will be jointly and severally liable for all obligations of this Fund during the entire period of membership in the Fund.</P> <P>(C) That the applicant will pay promptly any lawful premiums or assessments due as a member of the Fund.</P> <P>(D) That the Commissioner will approve or disapprove this application within the time allowed by O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-155&amp;title=34#" target="_newtab">34-9-155</a> following receipt by him of the application and all supporting information requested.</P> <P>(E) That the applicant will be notified by at least first class mail as to date (12:01 a.m.) coverage begins which is understood to be the effective date of membership in the Fund.</P> <P>(F) That the applicant will submit an "Application to Withdraw from </P> <P>Group Self-Insurance Fund" ninety (90) days prior to voluntary withdrawal from the Fund.</P> <P>(G) That the coverage under this membership shall be for Georgia operations only, including incidental coverage <I>in other States.</I></P> <P>(H) That the application will notify the Fund and the Commissioner within fourteen (14) days of any change in any of the information contained in questions (1) through (10) of this application. </P> <P>PLEASE SIGN BELOW - INDICATING THAT YOU HAVE READ AND UNDERSTAND THE ABOVE A. - H.</P> <P>______________________________</P> <P>(PRINT NAME OF APPLICANT)</P> <P>BY: __________________________</P> <P>______________________________</P> <P>(PRINT NAME)</P> <P>______________________________</P> <P>(PRINT TITLE)</P> <P>______________________________</P> <P>(DATE)</P> <P>AFFIDAVIT</P> <P>COUNTY________________________</P> <P>STATE ________________________</P> <P>I,____________________________________________________, the undersigned being the__________________________________________________of the</P> <P>(Title)</P> <P>_______________________________________________________________________</P> <P>(Name of Applicant)</P> <P>swear (or affirm) that to the best of my knowledge and belief, the statements contained in the application, including the accompanying documents, are true and complete.</P> <P>BY:______________________</P> <P>Sworn to and subscribed before me this_______________________________</P> <P>day of______________________, 19___.</P> <P>___________________________________</P> <P>NOTARY PUBLIC</P> <P>My Commission Expires______________</P> <P>EXHIBIT D</P> <P>OFFICE OF</P> <P>COMMISSIONER OF INSURANCE</P> <P><B>WARREN D. EVANS</B></P> <P>COMMISSIONER OF INSURANCE</P> <P>SAFETY FIRE COMMISSIONER</P> <P>INDUSTRIAL LOAN COMMISSIONER</P> <P>COMPTROLLER GENERAL</P> <P> SEVENTH FLOOR WEST TOWER</P> <P> FLOYD BUILDING</P> <P> 2 MARTIN LUTHER RING, JR. DRIVE</P> <P> ATLANTA, GEORGIA 30334</P> <P><B>APPLICATION FOR TERMINATION OF MEMBERSHIP</B></P> <P><B>IN GROUP SELF-INSURANCE FUND</B></P> <P>_______________________________________, a member in good standing of the _________________________________________ Fund, hereby applies to terminate its membership in the Fund effective ______________________ , which date will comply with O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-156&amp;title=34#" target="_newtab">34-9-156</a> requiring the member to give ninety (90) days advance written notice to the Fund and to the Commissioner. The applicant understands and agrees that it will remain jointly and severally liable for all obligations of the Fund as of the date of termination. The applicant will continue to comply with its obligations as an employer under O.C.G.A. Chapter 34-9 as follows: "Secure and maintain full insurance against his liability for payment of workmen's compensation to his employees or provide the State Board of Worker's Compensation with satisfactory proof of his financial ability to pay the compensation directly in the amount and manner and when due as provided in O.C.G.A. Chapter 34-9 ."</P> <P>__________________________________</P> <P>(PRINT NAME OF MEMBER)</P> <P>BY: ______________________________</P> <P>__________________________________</P> <P>(PRINT NAME)</P> <P>__________________________________</P> <P>(PRINT TITLE)</P> <P>__________________________________</P> <P>(DATE)</P> <P>AFFIDAVIT</P> <P>COUNTY_____________</P> <P>STATE _____________</P> <P>I,______________________________________________________, the undersigned being the _______________________________________________________ of the</P> <P>(Title)</P> <P>______________________________________________________________________</P> <P>(Name of Applicant)</P> <P>swear (or affirm) that to the best of my knowledge and belief; the statements contained in the application, including the accompanying documents, are true and complete.</P> <P>By:_________________________</P> <P>Sworn to and subscribed before me this________________________________</P> <P>day of_____________________, 19_____.</P> <P>____________________________________</P> <P>NOTARY PUBLIC</P> <P>My Commission Expires_______________</P> <P>EXHIBIT E</P> <P>OFFICE OF</P> <P>COMMISSIONER OF INSURANCE</P> <P><B>WARREN D. EVANS</B></P> <P>COMMISSIONER OF INSURANCE</P> <P>SAFETY FIRE COMMISSIONER</P> <P>INDUSTRIAL LOAN COMMISSIONER</P> <P>COMPTROLLER GENERAL</P> <P> SEVENTH FLOOR WEST TOWER</P> <P> FLOYD BUILDING</P> <P> 2 MARTIN LUTHER RING, JR. DRIVE</P> <P> ATLANTA, GEORGIA 30334</P> <P><B>APPLICATION TO SERVE AS</B></P> <P><B>OFFICER, DIRECTOR OR TRUSTEE OF</B></P> <P><B>GROUP SELF-INSURANCE FUND</B></P> <P>To the Commissioner of Insurance, State of Georgia, and the _____________________________________________________________ Fund:</P> <P>Application is hereby made to serve as ______________________ of the Fund.</P> <P>(If additional space is required to answer any question, use separate sheets of paper, numbering each to correspond to the question being answered.)</P> <P>(1) Name__________________________________________________________________</P> <P>(2) Address_______________________________________________________________</P> <P>(3) Telephone Number _____________________________________________________</P> <P>(4) Name of Fund _________________________________________________________</P> <P>(5) Address of Fund ______________________________________________________</P> <P>(6) Position applied for__________________________________________________</P> <P>(7) Term of Office _______________________________________________________</P> <P>(8) Duties________________________________________________________________</P> <P>(9) Date of Birth ________________________________________________________</P> <P>(10) Social Security Number ______________________________________________</P> <P>(11) Have you been convicted of any crime other than minor traffic violations within the last ten years? _____________________If so, explain. </P> <P>______________________________________________________________________</P> <P>_______________________________________________________________________</P> <P>(12) Are you an owner, officer, director, shareholder or employee of any administrator or any parent of affiliated company? ___________ If so, explain.____________________________________________________________ </P> <P>_______________________________________________________________________</P> <P>(13) Educational Background. List all institutions of higher learning, </P> <P>dates attended, areas of study and degrees received. Include any specialized training, courses or seminars.</P> <P>(14) Experience. List all relevant employment experience. Include at least three professional references. Include any specialized licenses in any state, memberships in professional, technical or honorary societies, publications, honors or awards. If any license has been refused, suspended, cancelled or revoked, explain.</P> <P>(15) Have you ever been an officer, director, trustee, investment committee member, key employee or major stockholder of any company which became insolvent, received a cease and desist order, was placed in receivership or conservatorship, was charged with any securities regulation or any insurance violation regulation? ___________________ If so, explain. _______________________________________________________________________ </P> <P>_______________________________________________________________________</P> <P>(16) Have you ever been declared bankrupt? ________________________ If so, explain. _________________________________________________________________ </P> <P>Enclose any proposed contract with the Fund providing for compensation to the applicant, organization, company or firm in which the applicant is interested.</P> <P>In consideration for the application, the applicant agrees as follows:</P> <P>(A) That the applicant will comply with all provisions of O.C.G.A. Chapter 34-9, the Regulations promulgated thereunder, all lawful Orders of the Commissioner, the Rules and Orders of the State Board of Workers' Compensation, the bylaws of the Fund and the terms of any contract with the Fund approved by the Commissioner.</P> <P>(B) THAT THE APPLICANT WILL BE IN A FIDUCIARY RELATIONSHIP WITH RESPECT TO ANY MONIES OF THE FUND RECEIVED, COLLECTED, DISBURSED, OR INVESTED._______ (Initial)</P> <P>(C) THAT NO FINANCIAL OBLIGATION OF THE APPLICANT WILL BE GUARANTEED BY THE FUND. ______(Initial)</P> <P>(D) THAT THE APPLICANT AND ANY COMPANY OR FIRM IN WHICH THE APPLICANT IS INTERESTED WILL NOT DEPOSIT OR INVEST THE FUND'S ASSETS EXCEPT IN THE NAME OF THE FUND, BORROW THE ASSETS OF THE FUND; BE PECUNIARILY INTERESTED IN ANY LOAN, PLEDGE OF DEPOSIT, SECURITY, INVESTMENT, SALE, PURCHASE, EXCHANGE, REINSURANCE OR OTHER SIMILAR TRANSACTION OR PROPERTY OF THE FUND; TAKE OR RECEIVE FOR HIS OWN USE ANY FEE, BROKERAGE, COMMISSION, GIFT, OR OTHER CONSIDERATION FOR OR ON ACCOUNT OF ANY SUCH TRANSACTION MADE BY OR ON BEHALF OF THE FUND; EXCEPT IN ACCORDANCE WITH O.C.G.A. SECTION <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-180&amp;title=34#" target="_newtab">34-9-180</a> OR FOR REASONABLE COMPENSATION FOR SERVICES PERFORMED OR SALES OR PURCHASES MADE TO OR FOR THE FUND IN ACCORDANCE WITH THE TERMS OF A CONTRACT APPROVED BY THE COMMISSIONER. ________(Initial)</P> <P>(E) That any contract providing for compensation from the Fund to the applicant or any company or firm in which the applicant is interested must be approved and may be modified by the Commissioner. In the event of modification by the Commissioner, the applicant reserves the right to withdraw this application.</P> <P>(F) That the applicant will notify the Fund and the Commissioner within fourteen (14) days of any change in any of the information contained in this application. </P> <P>______________________</P> <P>(NAME)</P> <P>AFFIDAVIT</P> <P>COUNTY___________</P> <P>STATE _____________</P> <P>I,____________________________________________________, the undersigned, being the __________________________________________________of the</P> <P>(Title)</P> <P>_______________________________________________________________________</P> <P>(Name of Applicant)</P> <P>swear (or affirm) that to the best of my knowledge and belief the statements contained in the application, including the accompanying documents, are true and complete.</P> <P>BY:_______________________</P> <P>Sworn to and subscribed before me this________________________________</P> <P>day of______________________, 19____.</P> <P>____________________________________</P> <P>NOTARY PUBLIC</P> <P>My Commission Expires_______________</P> <P>EXHIBIT F</P> <P>OFFICE OF</P> <P>COMMISSIONER OF INSURANCE</P> <P><B>WARREN D. EVANS</B></P> <P>COMMISSIONER OF INSURANCE</P> <P>SAFETY FIRE COMMISSIONER</P> <P>INDUSTRIAL LOAN COMMISSIONER</P> <P>COMPTROLLER GENERAL</P> <P> SEVENTH FLOOR WEST TOWER</P> <P> FLOYD BUILDING</P> <P> 2 MARTIN LUTHER RING, JR. DRIVE</P> <P> ATLANTA, GEORGIA 30334</P> <P><B>APPLICATION TO SERVE AS</B></P> <P><B>ADMINISTRATOR OF</B></P> <P><B>GROUP SELF-INSURANCE FUND</B></P> <P>To the Commissioner of Insurance, State of Georgia, and the __________</P> <P>__________________________________________________________________ Fund:</P> <P>Application is hereby made to administer the Fund.</P> <P>(If additional space is required to answer any question, use separate sheets of paper, number each to correspond to the question being answered.)</P> <P>(1) Name__________________________________________________________________</P> <P>(2) Address_______________________________________________________________</P> <P>(3) Telephone Number______________________________________________________</P> <P>(4) Name of Fund _________________________________________________________</P> <P>(5) Address of Fund ______________________________________________________</P> <P>(6) Status: () Corporation () Partnership () Individual</P> <P>(7) List Names and Addresses of Owners and Partners ______________________ </P> <P>_______________________________________________________________________</P> <P>(8) If Administrator is a company, list name and address of Resident Agent </P> <P>_______________________________________________________________________</P> <P>(9) List the names, addresses, and titles of the officers and directors of the administrator:</P> <P><U>Name</U><U>Address</U><U>Title</U></P> <P>(10) Have any of the above-named people been convicted of any crime other than minor traffic violations within the last ten years? _____________ If so, explain. _____________________________________________________________</P> <P>(11) Is any officer or trustee of the Fund an owner, partner, officer, </P> <P>director, stockholder or employee of the administrator or any parent or affiliate company? ______________ If so, explain. _______________________________________________________________________</P> <P>_______________________________________________________________________</P> <P>(12) Are you affiliated with or a subsidiary of a company licensed to transact insurance in this State? __________ If so, list names and address. </P> <P>______________________________________________________________________________________________________________________________________________</P> <P>(13) List all administrative services you intend to perform.</P> <P>(14) List those individuals primarily responsible for administering the </P> <P>Fund and give their experience and educational background including any license in this or any other state within the last ten years. If any license has ever been refused, suspended, cancelled or revoked, explain. Include all institutions of higher learning, dates attended and degrees received, any specialized training courses or seminars, membership in professional, technical or honorary societies, publications, honors or awards. List at least three different professional references for each individual.</P> <P>(15) Detail the organizational structure and staff, available facilities, equipment and support personnel, how the various administrative services will be performed, and indicate the location in the structure of each individual in question (14). </P> <P>Enclose a copy of your most recent audited statement of your financial condition (or the most recent annual statement if an insurance company) and of any agreement or contract between you and the Fund.</P> <P>In consideration for this application, the applicant agrees as follows:</P> <P>(A) That the applicant will comply with O.C.G.A. Chapter 34-9 , the </P> <P>Regulations promulgated thereunder, all lawful Orders of the Commissioner, the Rules and Orders of the State Board of Workers' Compensation, the rules, regulations and bylaws of the Fund and the terms of any contract with the Fund approved by the Commissioner.</P> <P>(B) THAT THE APPLICANT AND ITS EMPLOYEES WILL BE IN A FIDUCIARY RELATIONSHIP WITH RESPECT TO ANY MONIES OF THE FUND RECEIVED, COLLECTED, DISBURSED OR INVESTED. _______ (Initial)</P> <P>(C) THAT THE FUND WILL NOT GUARANTEE ANY FINANCIAL OBLIGATION OF the applicant OR ANY OF ITS EMPLOYEES._______(Initial)</P> <P>(D) THAT THE APPLICANT, ITS EMPLOYEES, AND ANY COMPANY OR FIRM IN which the APPLICANT IS INTERESTED WILL NOT DEPOSIT OR INVEST THE FUND'S ASSETS EXCEPT IN THE NAME OF THE FUND; BORROW THE ASSETS OF THE FUND; BE PECUNIARILY INTERESTED IN ANY LOAN, PLEDGE OF DEPOSIT, SECURITY, INVESTMENT, SALE, PURCHASE, EXCHANGE, REINSURANCE OR OTHER SIMILAR TRANSACTION OR PROPERTY OF THE FUND; TAKE OR RECEIVE FOR HIS OR THEIR OWN USE ANY FEE, BROKERAGE, COMMISSION, GIFT, OR OTHER CONSIDERATION OF THE FUND; EXCEPT IN ACCORDANCE WITH O.C.G.A. SECTION <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-180&amp;title=34#" target="_newtab">34-9-180</a>, OR FOR REASONABLE COMPENSATION FOR SERVICES PERFORMED OR SALES OR PURCHASES MADE TO OR FOR THE FUND IN ACCORDANCE WITH THE TERMS OF A CONTRACT APPROVED BY THE COMMISSIONER. ________ (Initial)</P> <P>(E) That any contract providing for compensation from the Fund to the applicant or any company or firm in which the applicant is interested must be approved and may be modified by the Commissioner. In the event of modification by the Commissioner, the applicant reserves the right to withdraw this application.</P> <P>(F) That the applicant will obtain and maintain a fidelity bond in the amount of $100,000 written by a company authorized to transact insurance in this State and will submit a copy of the bond to the Commissioner.</P> <P>(G) That the applicant will obtain errors and omissions coverage or other appropriate liability insurance written by a company authorized to transact insurance in this State, in the amount of at least $100,000, and that it will submit a copy of this policy to the Commissioner.</P> <P>(H) That the applicant will continuously maintain this policy throughout the term as administrator and will, if it desires to make any change in this policy, notify the Commissioner at least sixty (60) days before the proposed effective date of the change.</P> <P>(I) That the applicant notify the Fund and the Commissioner within fourteen (14) days of any change in any of the information contained in this application. </P> <P>____________________________</P> <P>(PRINT NAME OF ADMINISTRATOR)</P> <P>BY: ________________________</P> <P>____________________________</P> <P>(PRINT NAME)</P> <P>____________________________</P> <P>(PRINT TITLE)</P> <P>____________________________</P> <P>(DATE)</P> <P>EXHIBIT G</P> <P><B>OFFICE OF</B></P> <P><B>COMMISSIONER OF INSURANCE</B></P> <P><B>WARREN D. EVANS</B></P> <P>COMMISSIONER OF INSURANCE</P> <P>SAFETY FIRE COMMISSIONER</P> <P>INDUSTRIAL LOAN COMMISSIONER</P> <P>COMPTROLLER GENERAL</P> <P> SEVENTH FLOOR WEST TOWER</P> <P> FLOYD BUILDING</P> <P> 2 MARTIN LUTHER RING, JR. DRIVE</P> <P> ATLANTA, GEORGIA 30334</P> <P><B>GROUP SELF-INSURANCE BOND</B></P> <P>KNOW ALL MEN BY THESE PRESENTS, that ____________________________________</P> <P>______________________________________________________________________,</P> <P>a group self-insurance fund as defined in the laws of the State of ______, as Principal, _________________, a corporation duly incorporated under the laws of the State of ___________, as Surety, are held and firmly bound unto the State of Georgia in the full and just sum of ____________________ dollars, current money of the United States, to be paid to the State of Georgia, to the payment we hereby bind ourselves and each of us, our and each of our successors and assigns, jointly and severally, firmly by these presents, sealed with our seals and dated this _______ day of _________ A.D., 19____.</P> <P>WHEREAS, the above bounden __________________________ did on the _______ day of ____________________ , A.D., 19 _______, file with the Commissioner of Insurance of Georgia its application for a certificate of authority for group self-insurance fund under O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=34-9-152&amp;title=34#" target="_newtab">34-9-152</a>.</P> <P>AND WHEREAS, the Commissioner on the _______ day of _______, A.D.,</P> <P>19______, granted the application for the certificate of authority upon condition that _____________________ group self-insurance fund enter into bond in the penalty of _________ dollars conditioned among other things that the fund shall abide by and perform the requirements of the aforesaid Act with reference to paying or furnishing compensation, medical or surgical services, etc., and the rules and regulations that are now or may hereafter be adopted by the Commissioner of Insurance and the State Board of Workers' Compensation.</P> <P>NOW, THEREFORE, the condition of this obligation is such that if the above bounden __________________________ shall well and truly, from time to time, and at all times hereafter, abide by and perform all the requirements of the aforesaid Act and of any amendments thereto, as well as the rules and regulations that now are or hereafter may be adopted by the State board of Workers' Compensation of Georgia, respecting the payment of the Compensation to any covered injured employees or the dependents of killed employees, and the furnishing at its own cost the expenses of medical, surgical and other services, and funeral expenses as provide in the Act, then this obligation shall be void, otherwise to remain in full force and virtue in law.</P> <P>This Bond may be cancelled at any time by the Surety upon giving sixty (60) days written notice to the Commissioner of Insurance of Georgia, in which event liability of the Surety shall, at the expiration of the said sixty (60) days, cease and determine, except as to such liability of the Principal on account of injury or death to any covered employees, as may have accrued prior to the expiration of the sixty (60) days, it being understood that the Surety shall be liable, within the penal sum mentioned herein, for the default of the Principal in fully discharging any liability on its part accruing during the life of this obligation.</P> <P>IN WITNESS WHEREOF, the said Principal has caused these presents to be executed by the signature of the Chairman of its Board of Trustees and the said Surety has caused these presents to be executed by the signature of its _____________________________________ and its corporate seal affixed thereto (Agent or Attorney-in-Fact) with attestation where required.</P> <P>This ____________ day of ____________________, 19 ______.</P> <P>________________________________________</P> <P>(Principal) (Name of Fund)</P> <P>BY:_____________________________________</P> <P>Title: <U>Chairman, Board of Trustees</U>______</P> <P>________________________________________</P> <P>(Surety)(Name of Company)</P> <P>BY:_____________________________________</P> <P>Title: _________________________________</P> <P>Attest: ________________________________</P> <P>(If required by Power-of Attorney)</P> <P>Title: _________________________________</P> <P>________________________________________</P> <P>(SURETY'S SEAL) (Licensed Registered Agent)</P> <P>Attest as to Seal:</P> <P>BY: _____________________________</P> <P>Title: __________________________</P> <P>EXHIBIT H</P> <P><B>OFFICE OF</B></P> <P><B>COMMISSIONER OF INSURANCE</B></P> <P><B>WARREN D. EVANS</B></P> <P>COMMISSIONER OF INSURANCE</P> <P>SAFETY FIRE COMMISSIONER</P> <P>INDUSTRIAL LOAN COMMISSIONER</P> <P>COMPTROLLER GENERAL</P> <P> SEVENTH FLOOR WEST TOWER</P> <P> FLOYD BUILDING</P> <P> 2 MARTIN LUTHER RING, JR. DRIVE</P> <P> ATLANTA, GEORGIA 30334</P> <P><B>ADMINISTRATOR'S FIDELITY BOND FOR</B></P> <P><B>GROUP SELF-INSURANCE</B></P> <P>STATE OF GEORGIA</P> <P>COUNTY OF ___________________</P> <P>KNOW ALL MEN BY THESE PRESENTS:</P> <P>That ____________________________________________________________, whose place of business in the City of ________________________, as Principal, and __________________________________, as Surety, a corporation duly authorized to write surety bonds in this State, are held and firmly bound unto Warren D. Evans, Commissioner of Insurance, State of Georgia, and his successors in office in the penal sum of ONE HUNDRED THOUSAND DOLLARS ($100,000.00) lawful money of the United States of America, for the payment of which well and truly to be made, we bind ourselves, and each of our heirs, executors, administrators, successors and assigns jointly, severally and firmly by these presents:</P> <P>WHEREAS, the above bounden Principal pursuant to the provisions of O.C.G.A. Chapter 34-9 , entitled "Group Self-Insurance Funds," is about to apply or has applied to the Commissioner of Insurance of the State of Georgia to act as administrator of the _______________________________________________</P> <P>_______________________________________________ Fund.</P> <P>NOW, THEREFORE, the conditions of the above obligation are such that if the said above bounden Principal shall fully and faithfully comply with the requirements of the said Chapter, and the laws of this State, and shall properly account for all monies collected in connection therewith, then this obligation is to be void, otherwise to remain in full force and effect.</P> <P>This bond shall remain in full force and effect until the surety is released from liability by the Commissioner or until the bond is cancelled by the surety. The bond may not be cancelled or terminated unless sixty (60) days prior written notice is filed with the Commissioner.</P> <P>IN WITNESS WHERE OF, the said Principal has caused these presents to be executed by lawful signature under seal and the said surety has caused these presents to be executed by the signature of its_______________________________ and its corporate seal to be affixed</P> <P>(Agent or Attorney-in-Fact)</P> <P>there to, with attestation where required.</P> <P>This ________ day of _____________________________, 19____.</P> <P>_________________________________________</P> <P>(Principal)(Name of person, corporation, partnership, etc.)</P> <P>By: _____________________________________</P> <P>(ADMINISTRATOR'S SEAL) Title: __________________________________</P> <P>Attest: ____________________ Attest: _________________________________</P> <P>Title: _____________________ Title: __________________________________</P> <P>(Secretary of Assistant Secretary)</P> <P>By: _____________________________________</P> <P>(SURETY'S SEAL) Title: __________________________________</P> <P>Attest: ____________________ Attest: _________________________________</P> <P>(If required by Power-of-Attorney)</P> <P>Title: __________________________________</P> <P>_________________________________________</P> <P>(Licensed Registered Agent)</P> </div> </div> </HTML> </div> <div id="toc" class="sidebar noprint"> <ul id="toc-children" class="children"><li><a href="/GAC/120-2-34-.01" name="120-2-34-.01" title="120-2-34-.01">Rule 120-2-34-.01 Authority</a></li><li><a href="/GAC/120-2-34-.02" name="120-2-34-.02" title="120-2-34-.02">Rule 120-2-34-.02 Purpose</a></li><li><a href="/GAC/120-2-34-.03" name="120-2-34-.03" title="120-2-34-.03">Rule 120-2-34-.03 Definitions</a></li><li><a href="/GAC/120-2-34-.04" name="120-2-34-.04" title="120-2-34-.04">Rule 120-2-34-.04 Notice of Intent to Form a Fund</a></li><li><a href="/GAC/120-2-34-.05" name="120-2-34-.05" title="120-2-34-.05">Rule 120-2-34-.05 Application for Certificate of Authority</a></li><li><a href="/GAC/120-2-34-.06" name="120-2-34-.06" title="120-2-34-.06">Rule 120-2-34-.06 Renewal of Certificate of Authority</a></li><li><a href="/GAC/120-2-34-.07" name="120-2-34-.07" title="120-2-34-.07">Rule 120-2-34-.07 Application for Membership to a Fund</a></li><li><a href="/GAC/120-2-34-.08" name="120-2-34-.08" title="120-2-34-.08">Rule 120-2-34-.08 Termination of Membership</a></li><li><a href="/GAC/120-2-34-.09" name="120-2-34-.09" title="120-2-34-.09">Rule 120-2-34-.09 Application to Serve as Officer, Director or Trustee</a></li><li><a href="/GAC/120-2-34-.10" name="120-2-34-.10" title="120-2-34-.10">Rule 120-2-34-.10 Application to Serve as Administrator</a></li><li><a href="/GAC/120-2-34-.11" name="120-2-34-.11" title="120-2-34-.11">Rule 120-2-34-.11 Execution of Intrastate Agreement</a></li><li><a href="/GAC/120-2-34-.12" name="120-2-34-.12" title="120-2-34-.12">Rule 120-2-34-.12 Request for Additional Information</a></li><li><a href="/GAC/120-2-34-.13" name="120-2-34-.13" title="120-2-34-.13">Rule 120-2-34-.13 Financial Reporting: Annual and Quarterly Statements</a></li><li><a href="/GAC/120-2-34-.14" name="120-2-34-.14" title="120-2-34-.14">Rule 120-2-34-.14 Books and Records: Examination</a></li><li><a href="/GAC/120-2-34-.15" name="120-2-34-.15" title="120-2-34-.15">Rule 120-2-34-.15 Security Deposit</a></li><li><a href="/GAC/120-2-34-.16" name="120-2-34-.16" title="120-2-34-.16">Rule 120-2-34-.16 Specific and Aggregate Excess Insurance Program</a></li><li><a href="/GAC/120-2-34-.17" name="120-2-34-.17" title="120-2-34-.17">Rule 120-2-34-.17 Administrator's Bond and Errors and Omissions Coverage</a></li><li><a href="/GAC/120-2-34-.18" name="120-2-34-.18" title="120-2-34-.18">Rule 120-2-34-.18 Compensation of Administrator or Trustee</a></li><li><a href="/GAC/120-2-34-.19" name="120-2-34-.19" title="120-2-34-.19">Rule 120-2-34-.19 Rates and Premiums</a></li><li><a href="/GAC/120-2-34-.20" name="120-2-34-.20" title="120-2-34-.20">Rule 120-2-34-.20 Reserve Requirement</a></li><li><a href="/GAC/120-2-34-.21" name="120-2-34-.21" title="120-2-34-.21">Rule 120-2-34-.21 Dividends</a></li><li><a href="/GAC/120-2-34-.22" name="120-2-34-.22" title="120-2-34-.22">Rule 120-2-34-.22 Organization of a Fund</a></li><li><a href="/GAC/120-2-34-.23" name="120-2-34-.23" title="120-2-34-.23">Rule 120-2-34-.23 Penalties</a></li><li><a href="/GAC/120-2-34-.24" name="120-2-34-.24" title="120-2-34-.24">Rule 120-2-34-.24 Severability</a></li></ul> </div> </div> <!--content ends here--> <div id="footer" class="noprint"><span class="footer">Copyright &copy; 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