58-20-27. Application for self-insurance association--Form.An association proposing to self-insure its workers' compensation liability shall apply to the department for the authority to self-insure, using forms available from the department. The application shall include:(1)The association's name;(2)The location and mailing address of the association's principal office and where its books and records are kept;(3)The name and address of each member of the association;(4)A copy of the bylaws or plan of operation adopted by the association;(5)Proof of compliance with §58-20-28;(6)A sample copy of the agreement between the association and the members securing the payment of each member's workers' compensation liability;(7)A pro forma financial statement, on a form acceptable to the department, showing the financial ability of the association to pay the workers' compensation liability of its members; and(8)The required application fee. Source: SL 1995, ch 282, §3.
South Dakota Legal Code