What does ACORD 130 (2026/08) collect from a California employer?
ACORD 130 (2026/08) is the Workers Compensation Application. That title and edition are the ones printed in the countrywide property and casualty list of the ACORD Forms Index, revised September 8, 2026 (acord.org, checked October 5, 2026). A Stockton packing shed, a Manteca taqueria, or any other California employer uses this application to show the states of coverage, each work location, the people marked included or excluded, and a rating worksheet of class code, duties, headcount, and estimated annual payroll. It follows ACORD 125 when workers compensation is one of the lines requested. It is not a policy, and it does not set a price. The owner supplies the facts, a licensed agent writes them on the application, and an officer, owner, or partner signs. The August 2026 ACORD forms bulletin says edition 2026/08 replaced 2026/01, is for use on or after August 2026, and was filed and approved with all applicable states. Call (209) 670-1556. The Stockton office is 956 W Robinhood Dr.
What does the state rating worksheet collect?
Page 2 of the 2026/08 application is a state rating worksheet. The form says to attach another copy when more than one state is on the account. Each row asks for the location, the class code, the duties in words, full-time and part-time headcount, and estimated annual remuneration, which the form also labels payroll. Under the rows are the carrier's factor lines, from the experience modification through deposit, minimum, and total estimated annual premium. This office does not fill those lines, and this page is not a quote.
On a California account the class comes from the Workers' Compensation Insurance Rating Bureau of California. WCIRB is licensed by the state, is the Insurance Commissioner's designated statistical agent, and operates under the authority of the California Insurance Code (WCIRB, about us, checked October 5, 2026). The form prints an NCCI risk identification field and a separate field for another rating bureau or a state employer registration number. For a San Joaquin County employer we write the WCIRB number in that second field. A Manteca taqueria counts the paid cook and the paid dishwasher. A relative who only eats there is not a third employee. The coverage conversation is on our workers compensation page, and the later comparison of estimated payroll with the books is on the payroll audit note.
Who belongs on the include-or-exclude rows?
Page 1 lists partners, officers, and relatives who must be employed by the business, with ownership percent, duties, an included or excluded mark, class code, and remuneration. The form says included remuneration must also appear in the rating section.
Labor Code section 3700 requires every employer except the state to secure compensation, by an authorized insurer or by a certificate of consent to self-insure. The Division of Workers' Compensation says that duty applies with one employee, and that a roofer with no employees is still required to carry the insurance (dir.ca.gov, checked October 5, 2026). Section 3357 presumes that a person rendering service for another, other than as an independent contractor or unless expressly excluded, is an employee. Section 3351(c) includes officers and directors who render actual service for pay. They may elect out under section 3352(a)(16) if the officer owns at least 10 percent of the issued and outstanding stock, or at least 1 percent when a parent, grandparent, sibling, spouse, or child owns at least 10 percent and the officer has a health plan, and signs a written waiver under penalty of perjury. The waiver takes effect when the corporation's carrier receives and accepts it. Working partners and LLC managing members who take wages use section 3351(f) and the election in section 3352(a)(17). The excluded column is not that waiver. A Stockton corporation that wants its working president off the policy still needs the writing the carrier accepts. The hired cook stays on the worksheet. Contractor exemptions are on our contractor exemption note.
What do the yes-or-no questions ask a Valley crew?
Pages 3 and 4 say to explain every yes. Question 3 asks about work underground or above 15 feet. Question 7 asks whether any work is sublet without certificates of insurance, and the same line says a yes means that payroll goes on the state rating worksheet. A French Camp contractor who starts a framing crew with no certificate, and leaves that payroll off the sheet, has skipped the instruction on the question. How to request the certificate a job asks for later is on our certificate of insurance page. Question 11 asks about seasonal employees. A Charter Way packing shed that adds a night shift for the tomato run puts those wages on the worksheet, not in a remark that leaves the part-time count at zero. The form also asks about out-of-state travel, leased employees, and a decline, cancellation, or nonrenewal in the last three years. It says the nonrenewal question is not applicable in Missouri. Under the questions it asks for a description of operations and for five years of carriers and losses, or a loss run attached.
Who prepares the application, and who signs page 5?
Page 1 names the producer and the legal form: sole proprietor, partnership, corporation, subchapter S corporation, limited liability company, joint venture, trust, other, or unincorporated association. Status is quote, issue policy, bound, or assigned risk, and assigned risk says to attach ACORD 133. The forms index lists ACORD 133 (2025/05) as the Workers Compensation Insurance Plan, Assigned Risk Section. Locations are street, city, county, state, ZIP, and highest floor. A Charter Way cooler and a French Camp holding building are two rows. The policy block names the proposed dates, the part 1 states, the part 2 employers liability limits, and part 3 other states.
The August 2026 bulletin moved the applicant's signature, the producer's signature, and the national producer number from page 4 to a new page 5, and the form grew from four pages to five. The applicant must be an officer, owner, or partner, and represents that reasonable inquiry was made and that the answers are true, correct, and complete. Page 5 also holds Minnesota and Utah zero-exposure attestations. The Utah block requires written notice to the insurer within 60 days after employment begins. The heading says to complete the attestation for the state of coverage, so a California employer does not sign the Utah or Minnesota block. Page 4 marks the general fraud-statement block not applicable in California and points those states to a specific ACORD 38 notice. Insurance Code section 1631 requires a license to solicit, negotiate, or effect insurance unless that article provides an exemption. Section 332 requires each party to communicate material facts the other party cannot readily ascertain. We write the page with the owner at the Stockton office or by phone.
How does this application sit with ACORD 125?
ACORD 125 (2025/03) is the applicant information section. It names the business and marks the lines requested, including workers compensation. ACORD 130 is the workers compensation application behind that mark. It does not replace the applicant page, and the applicant page does not hold the class rows or the five-year loss grid. The front-page note is ACORD 125, in the forms library. General liability, when that line is also requested, is ACORD 126. The index also lists ACORD 130 CA (2023/01), the California Workers Compensation Application. The insurer's instructions name which form the file uses. The Spanish explanation is on the Spanish page. A shop putting its first two people on payroll can read how a two-employee business gets coverage.
What do Stockton and Valley files come back for?
These are the gaps we send back most often from Stockton, Manteca, French Camp, and other Central Valley employers. This is what we see at this office. It is not a published study. An owner is marked excluded with no waiver the carrier has accepted, or marked included with the wages left off the worksheet. A seasonal crew is in the duties sentence and missing from the headcount. Question 7 is yes, and the subcontract payroll the question says to add is blank. The description of operations is one word, so a taqueria, a fruit haul, and a crew working above 15 feet still look alike. The five-year grid is empty, and no loss run is marked attached.
Questions before the signature
What is ACORD 130?
ACORD 130 (2026/08) is the Workers Compensation Application. It records the states of coverage, the class and payroll on a state rating worksheet, and which partners, officers, or employed relatives are marked included or excluded. The ACORD Forms Index lists that edition, and the August 2026 forms bulletin says it replaced the 2026/01 edition.
Who fills out ACORD 130?
The employer supplies the payroll, the duties, the locations, and who works there. A licensed producer prepares the application. On the 2026/08 form the applicant's signature must be an officer, owner, or partner, and the producer signs with a national producer number. Those signature lines sit in the state-specific attestations section on page 5.
What does the state rating worksheet collect?
For each state, the worksheet asks for the class code, a description of duties, the location, full-time and part-time headcount, and estimated annual remuneration. Premium factor lines sit under those rows. This office does not print a price on this page.
Does a mark in the excluded column finish a California waiver?
No. Labor Code section 3351 treats a corporate officer who renders actual service for pay as an employee, and section 3352 requires a written waiver that the corporation's insurer receives and accepts. The include-or-exclude column on ACORD 130 is the underwriting record. It is not that waiver.
Does ACORD 130 replace ACORD 125?
No. ACORD 125 (2025/03) is the applicant information section of the commercial insurance application. ACORD 130 is the workers compensation application that follows when that line is part of the submission. The Forms Index also lists ACORD 130 CA (2023/01), the California Workers Compensation Application. The insurer's instructions name which workers compensation form the file uses.
Sources
- ACORD Forms Index (acord.org, index revised September 8, 2026, checked October 5, 2026). ACORD 130 (2026/08), Workers Compensation Application; ACORD 125 (2025/03), Commercial Insurance Application, Applicant Information Section; ACORD 133 (2025/05), Workers Compensation Insurance Plan, Assigned Risk Section; ACORD 130 CA (2023/01), California Workers Compensation Application.
- ACORD Forms Notification Service, August 2026 bulletin (notice dated September 8, 2026). ACORD 130 (2026/08) replaced 2026/01, for use on or after August 2026, filed and approved with all applicable states. Signature block moved to a new page 5. Utah zero-exposure attestation added. Checked October 5, 2026.
- Montana State Fund, public copy of ACORD 130 (2026/08). Field labels on this page, including the rating worksheet, the include-or-exclude block, question 7, and the note that the general fraud block is not applicable in California, are taken from that five-page copy. Checked October 5, 2026.
- California Labor Code section 3700, section 3351, section 3352, and section 3357 (leginfo.legislature.ca.gov, checked October 5, 2026). DIR, Division of Workers' Compensation, employer information. WCIRB California, about us. Insurance Code section 332 and section 1631.
Related: ACORD forms library · Workers compensation insurance · Workers compensation cost calculator · Esta página en español.
Reviewed by Santo Militello, California-licensed Property & Casualty agent (CA License #1737723). Insurance City Agency, LLC, CA License #6003045. Our licensed team brings more than 70 years of combined insurance experience. Phone (209) 670-1556. Insurance City, 956 W Robinhood Dr, Stockton, CA 95207.