Association Sponsors

Each of the associations listed below has partnered with Frank Gates/Avizent to sponsor a group rating program. To receive a free, no-obligation savings analysis through one of these associations, click on the PDF links below and download a BWC Temporary Authorization (AC-3) Form. Fill out completely, sign and return to Frank Gates, P.O. Box 182364, Columbus, OH 43218-2364, or fax to 614-798-5510. Alternatively, you can submit an AC-3 Form electronically by clicking here. We will then examine your workers’ compensation records, determine your eligibility for group rating and send you a savings estimate.

Association

AC-3 (PDF)
Air Conditioning Contractors of America, Ohio Chapter (ACCA-OH) AC-3
American Council of Engineering Companies of Ohio (ACEC of Ohio) AC-3
American Institute of Architects (AIA) AC-3
Bucyrus Area Chamber of Commerce (BACC) AC-3
Building Owners and Managers Association (BOMA) AC-3
Coalition on Homelessness and Housing in Ohio (COHHIO/OCC) AC-3
Columbus Medical Association (CMA) AC-3
Darke County Chamber of Commerce (DCCC/DACC) AC-3
Dayton Area Chamber of Commerce (DACC) AC-3
Dayton Tooling and Manufacturing Association (DTMA) AC-3
Fairborn Area Chamber of Commerce (FACC/DACC) AC-3
Greater Cleveland Safety Council (GCSC) AC-3
Greater Springfield Chamber of Commerce AC-3
Kettering Moraine Oakwood Chamber of Commerce (KMO) AC-3
Milford Miami Township Chamber of Commerce (MMTC) AC-3
National Association of the Remodeling Industry (NARI) AC-3
North American Retail Hardware Association (NRHA) AC-3
Northmont Area Chamber of Commerce (NACC/DACC) AC-3
Ohio Association of Foodservice and Pizza Operators (OAFPO) AC-3
Ohio Association of Independent Schools (OAIS) AC-3
Ohio Association of McDonald's Operators (OAMO) AC-3
Ohio Auto and Truck Recyclers Association (OATRA) AC-3
Ohio Body Shop Owners Association (OBOA) AC-3
Ohio Campground Owners Association (OCOA) AC-3
Ohio Chamber of Commerce (OCOC) AC-3
Ohio Cleaners Association (OCA) AC-3
Ohio Community Corrections Association (OCCA) AC-3
Ohio Contractors Association (OCA) AC-3
Ohio Council of Churches (OCC) AC-3
Ohio Dental Association (ODA) AC-3
Ohio Farmers Union (OFU) AC-3
Ohio Golf Course Owners Association (OGCOA) AC-3
Ohio Harness Horsemen's Association (OHHA) AC-3
Ohio Lake Communities Association (OLCA) AC-3
Ohio Land Title Association (OLTA) AC-3
Ohio Library Council (OLC) AC-3
Ohio Manufactured Homes Association (OMHA) AC-3
Ohio Optometric Association (OOA) AC-3
Ohio Pest Management Association (OPMA) AC-3
Ohio Pharmacists Association (OPA) AC-3
Ohio Propane Gas Association AC-3
Ohio Society of Certified Public Accountants (OSCPA) AC-3
Ohio State Bar Association (OSBA) AC-3
Ohio Township Association (OTA) AC-3
Ohio Water Well Association (OWWA) AC-3
Ohio Wholesale Marketers Association (OWMA) AC-3
Pickaway County Chamber of Commerce AC-3
Preble County Chamber of Commerce (EPCC/DACC) AC-3
Tipp City Area Chamber (TCAC/DACC) AC-3
Trotwood Chamber of Commerce (TMCC/DACC) AC-3
Troy Area Chamber of Commerce (TACC) AC-3
Waynesville Area Chamber of Commerce (WYCC/DACC) AC-3
Wilmington-Clinton County Chamber of Commerce (WCCC/DACC) AC-3
General AC-3

Printing an AC-3 Form?

To download these printable AC-3 forms, you must have the Adobe Reader. You can download free Adobe Reader software if you don’t already have the program installed on your computer.

Questions?

Call 800-395-4119 or fill out our Request Form.