Please complete an Acord application and fax/mail it to the KESA office. Please do not place submissions more than 90 days prior to effective date. A complete submission should include:

1. Acord 130 Workers' Compensation Application (be sure to include the company's federal ID number - no application can be accepted without one!).
2. Insurance company loss runs for the current policy year and three (3) preceding years. The loss runs should have current valuation dates.