|
Home |
Business
Safety Tips |
Workplace Safety |
Casualty
Insurance Programs |
Join Us |
News |
Workmen's Comp |
Workmen's Comp
Instructions
C.F.F.
California Fast
Food
Safety Association
Join
Us
C.F.F.
California Fast Food Safety
Association
Membership Application
D.B.A:
_________________________________________________________________
Contact
Person:__________________________________________________________
Address:_________________________________________________________________
City:____________________ State:_____________ Zip
Code:___________________
Phone:
(______)_________________ Fax:
(______)___________________
Business
Email:____________________________________________________________
Policy #:
_________________________________________________________________
Agent Name
and #: _________________________________________________________
Agent
Address: _____________________________________________________________
Phone: (______)____________ Fax: (______)_______________ EM:_________________
Annual Membership is
$100.00 (for each additional location, add $100.00)
Payment made
payable to:
C.F.F.
c/o Osborne Insurance
1419
Burlingame Avenue Suite O Burlingame CA 94010
Tel: (650)-347-1717 * Fax: 650-347-1707
1.
New business: with governing class code 9079 (Restaurants or Taverns –
All Employees Including Musicians and Entertainers “Fast Food”) must be
submitted on an ACCORD
WORK COMP APPLICATION (FORM 130) directly to
the Western Work Comp Center.
2.
Indicate in the “DIVIDEND PLAN/SAFETY GROUP” section of the WORK COMP
accord application
“C.F.F” safety group.
3.
Attach a photocopy of this “C.F.F MEMBERSHIP APPLICATION” to the WORK
COMP Accord
application that you are sending to the Western
Work Comp Center.
Send the
original C.F.F. MEMBERSHIP APPLICATION to:C.F.F. c/o Osborne Insurance
1419
Burlingame Avenue Suite O Burlingame CA 94010
4.
ROLLING EXISTING BUSINESS (regardless of expiration date) Submit an
ACCORD CHANGE
REQUEST APPLICATION (Form 175) requesting
rollover into the C.F.F. Safety group program.
Submit all documentation to the appropriate
regional office, and then follow instructions (3) and (4).
5.
Make membership check ($100/$100 each additional location])
Payable to: CFF. c/o Osborne Insurance
1419 Burlingame Avenue Suite O
Burlingame CA 94010
C.F.F.
c/o © Kevin Osborne Insurance Agency
1419
Burlingame Avenue, Suite 0 | Burlingame, California 94010
Phone: (650) 347~1717 | Fax: (650) 347~1707
California License Number: 0777515
|
