Claims - Filing a Professional Employer Organization (PEO) Agreement

Claims Division
Filing a Professional Employer Organization (PEO) Agreement

Ruby Tate, Claims Manager
Email: [email protected]
Phoenix: 800 W Washington St, Phoenix AZ 85007 - Phone: (602) 542-4661
Tucson: 2675 East Broadway, Tucson AZ 85716 - Phone: (520) 628-5181
FAX (use for either office): (602) 542-3373

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Filing a Professional Employer Organization (PEO) Agreement

Click here to download form :     Claims_ProfessionalEmployerAgreement.pdf

A Professional Employer Organization (PEO) is required to file this Notice with the PEO's Workers' Compensation Insurance Carrier and The Industrial Commission of Arizona when a PEO enters into a Professional Employer Agreement with a client in Arizona.