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Renewal
It is important that you follow these instructions carefully. Improper reporting may result in your contribution/assessment being too high or failure to report some exposures. We developed one generic application to apply to all types of entities, so some of the items may not apply to your entity. If an item does not apply to your entity, fill in “N/A”.
DEDUCTIBLE: Please remember, you pay the deductible for each separate claim. You should budget funds each year to pay deductibles. You only pay a deductible if our office makes a claim payment. Defense costs (attorney fees, adjuster fees, etc.) are not part of the deductible. LGLP picks up these costs.
PAYROLL EXPENDITURES: We use total payroll to calculate your annual contribution assessment. Total payroll is based on your “Employer’s Quarterly Federal Tax Return – Form 941” or annual Form 943 or Form 944. Please attach all forms for the preceding tax year. That means if you submit Form 941s to the IRS, you will need to submit a copy of the first page of all four Form 941s that were submitted for the past year.
COMPLETION OF APPLICATION BY LGLP STAFF: Entities may request LGLP staff to complete section 2 – payroll expenditures of the application. If you are unsure as to what payroll expenditures to report, you may complete the informational portion of the application and forward the application to us for completion of the payroll expenditure section. For our staff to complete the payroll expenditure section of the application, we will need a copy of the entity's “Employer’s Quarterly Federal Tax Return – form 941.”
QUESTIONS: If you have any questions regarding the application, please do not hesitate to give us a call – we are here to help you.
Call:
- Mark Pring, Executive Director
Business Phone Number: 307-638-1911
Toll Free Phone Number: 1-888-433-1911
E-mail Address: lglp@bresnan.net
Printable Renewal Membership Application (PDF)
Printable Renewal Membership Application (MS Word)
Instructions for Applications |
