Workers’ Compensation Division Preferred Worker Placement Assistance AgreementAssistance Agreement • October 3rd, 2020
See OAR 436-110-0345(4) for more information. If you have questions or need more help, contact the Preferred Worker Program in Salem, 503-947-7588; 800-445-3948 (toll-free); fax 503-947-7581.
Workers’ Compensation Division Preferred Worker Wage Subsidy AgreementAugust 10th, 2020
See OAR 436-110-0336; 436-110-0337 for more information. If you have questions or need more help, contact the Preferred Worker Program in Salem, 503-947-7588; 800-445-3948 (toll-free); fax 503-947-7581.
Workers’ Compensation Division Preferred Worker Worksite Creation AgreementNovember 10th, 2020
See OAR 436-110-0345(2)(i) for more information. If you have questions or need more help, contact the Preferred Worker Program in Salem, 503-947-7588; 800-445-3948 (toll-free); fax 503-947-7581.
MEMORANDUM OF UNDERSTANDINGMemorandum of Understanding • May 5th, 2020
This is a memorandum of understanding between and the State of Oregon, Department of Consumer and Business Services, Workers’ Compensation Division. As used in the memorandum of understanding, “self-insured employer” means and all subsidiaries and affiliated entities approved by the department and included in the employer’s self-insurance certification and any new entities approved by the department and included in the employer’s self-insurance certification.
Note: Print this Fee Discount Agreement on the medical service provider’s or clinic’s letterhead.September 4th, 2020
Workers’ Compensation Division Preferred Worker Moving Assistance AgreementAssistance Agreement • September 17th, 2020
See OAR 436-110-0345(2)(f) for more information. If you have questions or need more help, contact the Preferred Worker Program in Salem, 503-947-7588; 800-445-3948 (toll-free); fax 503-947-7581.
SECURITY AGREEMENT ANDSecurity Agreement • October 7th, 2020 • Oregon
This Security Agreement and Notice to Intermediary (“Agreement”) dated , 200 is between (“Pledgor”), the State of Oregon, acting by and through its Department of Consumer and Business Services Workers’ Compensation Division, 350 Winter Street NE, P.O. Box 14480, Salem, Oregon 97309-0405 (“Department”), and (“Intermediary”). The purpose of this Agreement is to effectuate the Pledgor’s election, pursuant to ORS 656.407, to (a) establish proof of financial ability to act as a self-insured employer by depositing money, debt or equity securities, instruments or other surety with a financial institution or brokerage firm such as the Intermediary, (b) grant the Department a security interest in or pledge of those financial assets held with the Intermediary, and (c) notify and obtain acknowledgment by the Intermediary of the Department’s security interest in and control over those financial assets.
Workers’ Compensation Division Group Self-Insured Indemnity AgreementAugust 23rd, 2020
for the payment of any compensation due a subject worker and other amounts due a subject worker and other amounts due to the Oregon Workers’ Compensation Division under ORS 656 incurred by a member of the group. Further, I (We) understand and agree that should I (We) terminate from the group that I (We) will continue to be jointly and severally liable for the payment of any compensation due a subject worker and other amounts due the Workers’ Compensation Division when such compensation and other amounts arise out of a period when I (We) was (were) a member(s) of the group. It is further understood and agreed that if an order is issued by the Workers’ Compensation Division declaring the group to be in noncompliance under the provision of ORS 656.017, that I (We) shall be jointly and severally liable for any civil penalties assessed under ORS 656.735 and any claim costs incurred under ORS 656.054.
STATE OF OREGON DEPARTMENT OF CONSUMER AND BUSINESS SERVICES Workers’ Compensation DivisionOctober 2nd, 2020
In consideration of the mutual agreements herein contained, the Principal and the Surety hereby consent to changing the (check one) penal sum Principal penal sum and Principal
Workers’ Compensation Division Preferred Worker Employment Purchase AgreementEmployment Purchase Agreement • September 26th, 2020
See OAR 436-110-0345 for more information. If you have questions or need more help, contact the Preferred Worker Program in Salem, 503-947-7588; 800-445-3948 (toll-free); fax 503-947-7581.
Note: Print this Indemnity Agreement on company letterhead.August 26th, 2020
(the “Parent”), guarantees payment of the compensation, assessments, contributions, or other amounts that may become due under the provisions of Oregon Revised Statute (ORS)
