Required Exclusion Waiver Form
Officer/Director
Dear Valued Client,

Now that Samuel Hale has switched insurance carriers, as policyholder, we must ensure that your workers’ compensation insurance policy complies with California Assembly Bill 2883 by having you complete a new Officer/Director Exclusion Waiver form.

Although you have completed this form for our previous carrier, a new signed and dated form is required to submit to our new carrier, ARCH.

Please download this Exclusion Waiver form and take a few minutes complete, sign and date it. Upon completion, please reply to this email and attach a copy of the waiver to it.

Thank you for your patience and continued support. Please feel free to contact me directly, should you have any questions

Sincerely,

Cory Twigg
Chief Experience Officer