164-22 Exhibits to Agreement for Workers Compensation Third Party Administration - 2022.pdf

rr Certification 52337, cee OF EMPLOYEE INFORMATION REPORT RENEWAL den das “ie 2 sNegenor naib appre ployee informailon Report pursuant to aport. This approval will remain in NALA.C. 17:27-1.1-6t. seq, and the effect for the perlod of 15-4RR CLAIMS RESOLUTION CoRPOR exon. 323 PEINBY ROAD, SUITE 209 GALLOWAY NJ 08205 ELIZABETH MAHER MUQIO State Treasurer uy if i