Declaration of Application
Applicant hereby applies for membership in the Hotel Motel Safety
Association (“Association”). Applicant agrees to timely pay
all
Group Workers’ Compensation premiums, deposits and membership
fees when due. Applicant unde
rstands and agrees that upon
Applicant’s failure to pay any outstanding financial obligations
due on his/her account to the in
surer, premium discounts will
be
revoked and you will cease to be an Association member. Applicant
gives the Association Power of Attorney to obtain and use, i
n
the interest of the Association, any information held by the
Insurer relating to claims, expe
rience rating, loss prevention ser
vices or
other information that may be the subjec
t of Association research and inquiry.
Applicant hereby agrees to follow and post a written (SB198) Wo
rkplace Safety Program, prescribed by Cal-OSHA, including, but
not limited to, holding quarterly safety meetings with all employees.