Georgia Self-Insurers Guaranty Trust FundGeorgia Self-Insurers Guaranty Trust Fund

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DOWNLOADABLE DOCUMENTS

Application Form

Addition of Company Form

Letter of Credit Language

Surety Bond Language

Loss Portfolio Transfer and Assumption Agreement (Employer no longer exists)

Loss Portfolio Transfer and Assumption Agreement (Employer still exists)

Loss Portfolio Transfer Addendum

GSIGTF Statute

GSIGTF statute

Specific Excess Workers’ Compensation Cancellation Endorsements

Bankruptcy Endorsement

Ace American Insurance Company

Arch Insurance Company

Associated Electric & Gas Insurance Services (AEGIS)

Benchmark Insurance Company

Everest National Insurance Company

Great West Casualty Company

Hartford Casualty Insurance Company

Liberty Mutual Insurance Company

Midwest Employers Casualty Company

National Union Fire Insurance Company of Pittsburgh

New York Marine and General Ins Co

Old Republic Insurance Company

Prescient National Insurance Services

Protective Insurance Co

Safety National Casualty Corporation

Sompo Japan Insurance Company of America

Star Insurance Company

Starr Indemnity & Liability Company

State National Insurance Company

Travelers Property Casualty Company

XL Specialty Insurance Co

Zurich American Insurance Company

Georgia Self-Insurers Guaranty Trust Fund
Mailing Address:
PO Box 57047, Atlanta, GA 30343

303 Peachtree Street, Suite 3500,
Atlanta, GA 30308

E-Mail: gafund@deflaw.com

Telephone: 404.872.6148

BOARD OF TRUSTEES

Sam Storey (Chairman)

Wellstar Health System, Inc.

Liz Smith (Secretary)

The Southern Company

Sheldon Fram

C.W. Matthews Contracting Company, Inc.

Bill Whitmire

Shaw Industries Group, Inc.

Greg Finch

Norman W. Fries, Inc.

Karen Wilkins

Waffle House, Inc.

ADMINISTRATOR

Matthew A. Nanninga