INDIVIDUAL AND PROPORTIONATE INDEMNITY AGREEMENT
WHEREAS, (name of company) has agreed to be and has been accepted as a member of (name of commercial self-insurance group).
WHEREAS, (name of company) has agreed to be bound by all of the provisions of the Minnesota Workers' Compensation Act and all rules promulgated thereunder.
WHEREAS, that (name of company) has agreed to be bound by bylaws or plan of operation and all amendments thereto of (name of commercial self-insurance group);
NOW THEREFORE, IT IS AGREED that:
IN WITNESS WHEREOF, the (name of company) and (name of commercial self-insurance group) have caused this indemnity agreement to be executed by its authorized officers:
Commercial Self-Insurance Group Name | Company Name |
By: ........................................................................................... | By: ....................................................................... |
date: ........................................................................................ | date: .................................................................... |
Minn. Stat. § 79A.27
1995 c 231 art 2 s 36