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C.F.F.
California Fast Food
Safety Association

 Join Us

                   

C.F.F.

California Fast Food Safety Association

Membership Application

 

D.B.A: _________________________________________________________________

 

Contact Person:__________________________________________________________

 

Address:_________________________________________________________________ 

 

City:____________________   State:_____________        Zip Code:___________________  

 

Phone: (______)_________________                   Fax:  (______)___________________

 

Business Email:____________________________________________________________

 

Policy #:  _________________________________________________________________

 

Agent Name and #: _________________________________________________________

 

Agent Address: _____________________________________________________________


Phone: (______)____________ Fax:  (______)_______________ EM:_________________ 

 

                       Annual Membership is $100.00 (for each additional location, add $100.00)

 

                             Payment made payable to:

                                            C.F.F. c/o Osborne Insurance

                    1419 Burlingame Avenue Suite O Burlingame CA 94010

 

Tel: (650)-347-1717 * Fax: 650-347-1707

 

 

 

1.        New business: with governing class code 9079 (Restaurants or Taverns – All Employees Including Musicians and Entertainers “Fast Food”) must be submitted on an ACCORD   

                          WORK COMP APPLICATION (FORM 130) directly to the Western Work Comp Center.

 

2.        Indicate in the “DIVIDEND PLAN/SAFETY GROUP” section of the WORK COMP accord application 

                            “C.F.F” safety group.

 

3.        Attach a photocopy of this “C.F.F MEMBERSHIP APPLICATION” to the WORK COMP Accord 

                        application that you are sending to the Western Work Comp Center.

       Send the original C.F.F. MEMBERSHIP APPLICATION to:C.F.F. c/o Osborne Insurance

       1419 Burlingame Avenue Suite O Burlingame CA 94010

 

4.        ROLLING EXISTING BUSINESS (regardless of expiration date) Submit an ACCORD CHANGE

                        REQUEST APPLICATION (Form 175) requesting rollover into the C.F.F. Safety group program. 

                         Submit all documentation to the appropriate regional office, and then follow instructions (3) and (4).

 

5.        Make membership check ($100/$100 each additional location])

Payable to:                   CFF. c/o Osborne Insurance

                                   1419 Burlingame Avenue Suite O Burlingame CA 94010


 

C.F.F. c/o Kevin Osborne Insurance Agency
1419 Burlingame Avenue, Suite 0  |  Burlingame, California 94010
Phone: (650) 347~1717  |  Fax: (650) 347~1707
California License Number: 0777515