Name and address of insurer: ......................................................................................................................
Name and address of insured employer: ....................................................................................................
Policy period: .................................................................................................................................................
I certify that the employer named above generates $250,000 or more in annual countrywide written workers' compensation premiums, and that the calculation of this threshold is based on the rates and rating plans that have been approved by the appropriate state regulatory authority. The filing of this certification authorizes the use of this rate or rating plan only for the named employer.
Name of responsible officer: ..........................................................................................................................
Title: ..................................................................................................................................................................
Signature: .........................................................................................................................................................
[Repealed, 1995 c 231 art 1 s 36; art 2 s 110]
Any insurer using a rate or a rating plan which has not been filed or certified under subdivision 1 shall be subject to a fine of up to $100 for each day the failure to file continues. The commissioner may, after a hearing on the record, find that the failure is willful. A willful failure to meet filing requirements shall be punishable by a fine of up to $500 for each day during which a willful failure continues. These penalties shall be in addition to any other penalties provided by law.
[Repealed, 2009 c 178 art 1 s 69]
Minn. Stat. § 79.56
1981 c 346 s 27; 1983 c 289 s 114 subd 1; 1984 c 655 art 1 s 92; 1995 c 231 art 1 s 9, 10; 2001 c 131 s 16; 2002 c 336 s 4; 2005 c 132 s 26, 27