Do you have a current written safety plan?
This is not an application for enrollment.
Signing this release gives BIAW permission to contact anyone at the above listed company via mail, email, and phone for any BIAW-related matters.
You are hereby authorized to provide our company's premium, claims history, losses, statistics, experience modification factor, and related industrial data, including all sub-accounts tied to the policy whether inactive or active, to the Building Industry Association of Washington along with access to the Department's online Claim & Account Center.
Please sign the box using your mouse, finger, or stylus. We will notify you by email when we receive your submission.