Section 230-RICR-20-15-1.4 - Application RequirementsA. The application to the Department shall be accompanied by all of the following: 1. a copy of the by-laws of the group self-insurer which shall include the group self-insurer's assessment and dividend policies.2. an individual application for membership in the group self-insurer, each member of the group self-insurer applying for coverage as of its inception date;3. proof that the current financial statements of each member of the group self-insurer at its inception, when taken collectively, show all of the following: a. that the combined net assets of the members applying for coverage on the inception date are not less than five hundred thousand dollars ($500,000);b. that they have working capital in an amount establishing the financial strength and liquidity of their businesses when considered collectively;4. evidence of the financial ability of the group self-insurer to meet its obligations under the Workers' Compensation Act;5. a listing of the estimated annual premium to be developed by each member of the group self-insurer at its inception date;6. proof of payment by each member of the group self-insurer at its inception date of not less than twenty five percent (25%) of its estimated annual premium into a designated depository;7. confirmation of excess insurance in amounts designated by the Department;8. names, addresses, and current business affiliations of the initial board of trustees and the administrator;9. proof of all fidelity bonds required by the Department in amounts and form acceptable to him;10. proof of a surety bond or other acceptable security in an amount and form acceptable to the Department;11. an indemnity agreement in a form acceptable to the Department jointly and severally binding the group self-insurer and each member thereof for all of the obligations of the group incurred during the period of membership;12. a breakdown of all projected administrative expenses for the year, both in dollar amounts and as percentages of premium;13. proof, satisfactory to the Department, that the annual gross premiums of the group self-insurer will be not less than two hundred fifty thousand dollars ($250,000);14. proof that the group self-insurer has within its own organization ample facilities and competent personnel to service its program with respect to underwriting, industrial safety engineering, claims adjusting, and reporting of loss data or has contracted for the provision of any or all such services.230 R.I. Code R. 230-RICR-20-15-1.4