If you have any eligibility questions or need help with forms, etc. please feel free to call our office

State Fund Submissions


Acord 130 - completed
State Fund Supplemental
3-5 Years of currently valued loss runs or New Venture Questionnaire if No Prior WC
Premiums Paid for the last 4 years (if applicable)
Payroll for the last 4 years (if applicable)


Send Complete submissions toCSR@RichterRobb.com

All Submisisons should include


Acord 130 - completed
Berkshire Supplemental - unless submitting to state fund
3-5 Years of currently valued loss runs or New Venture Questionnaire if No Prior WC







Forms

How to Submit: Workers Comp