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POLICYHOLDER NOTICE <br />CALIFORNIA <br />LOSS CONTROL CONSULTATION SERVICES <br />As required by law our company will provide Loss Control Consultation Services. These services will include, but are not <br />limited to the following: <br />(1) A workplace survey, including discussions with management and, where appropriate, nonmanagement personnel with <br />permission of the employer. <br />(2) A review of injury records with appropriate personnel. <br />(3) The development of a plan to improve the employer's health and safety loss control experience, which shall include, <br />where appropriate, modifications to the employer's injury and illness prevention program established pursuant to <br />Section 6401.7. <br />These services are available to you at no additional charge. <br />Please contact us at the following number if you have any questions regarding this service: <br />Loss Control Department <br />FirstComp Insurance Agency <br />222 South 15th Street, Suite 1500N, Omaha, NE 68102-1680 <br />1-888-500-3344 <br />Workers compensation insurance policyholders may register comments about the insurer's loss control consultation <br />services by writing to: <br />State of California, Department of Industrial Relations <br />Division of Occupational Safety and Health <br />P.O. Box 420603, San Francisco, CA 94142. <br />MPWC 1000 05 10 <br />26 of 28 <br />