| For Participants > Downloads |
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| Health and Welfare |
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Adult Child Enrollment Form.pdf
Delta Dental Claim Form (Excludes Retirees).pdf
Delta Dental Evidence of Coverage (Excludes Retirees).pdf
Disability Packet.pdf
Disability Packet (Español).pdf
Domestic Partner Application.pdf
Domestic Partner Application (Español).pdf
Hearing Aid Claim Form.pdf
Medco Information (Indemnity Only)
Medco Mail Order Prescription Form (Indemnity Only)
Medco Prescription Drug Reimbursement Form (Indemnity Only) Medical Claim Form (Indemnity Active Carpenters Only).pdf
Notice of Creditable Coverage .pdf
Notice of Privacy Practices.pdf Orthodontic Claim Form.pdf
Physical Exam Form (Indemnity Only).pdf
Protected Health Information Authorization Form.pdf
Protected Health Information Authorization Form (Español).pdf
Protected Health Information Revoke Authorization Form.pdf
Protected Health Information Revoke Authorization Form (Español).pdf
Supplemental Weekly Disability Continuation Form.pdf
| Health and Welfare: Plan A and R |
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Plan Comparison.pdf
Plan Comparison (Español).pdf
Summary Plan Description - Rules & Regs - Amendments.pdf
Summary Plan Description - Rules & Regs - Amendments (Español).pdf
| Health and Welfare: Plan B and Flat Rate |
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Plan Comparison.pdf
Plan Comparison (Español).pdf
Summary Plan Description - Rules & Regs - Amendments.pdf
Summary Plan Description - Rules & Regs - Amendments (Español).pdf
| Health and Welfare: Retiree |
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Health and Welfare Self Pay Rates.pdf
Medical Claim Form (Indemnity Retirees Only).pdf
Plan Comparison.pdf
Plan Comparison (Español).pdf
Retiree Dental Options.pdf
Retiree Dental Premiums.pdf
Summary Plan Description - Rules & Regs - Amendments.pdf
Summary Plan Description - Rules & Regs - Amendments (Español).pdf
| Pension |
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Annual Funding Notice & Notice of Critical Status
Application for Retirement.pdf
Application for Retirement (Español).pdf
Direct Deposit Election Form.pdf
Direct Deposit Election Form (Español).pdf
Disability Packet.pdf
Disability Packet (Español).pdf
IRS Form W-4P - Withholding Certificate for Pension or Annuity Payments.pdf
Notice to Interested Parties
Report of Summary Plan Information
Summary Plan Description - Rules & Regs - Amendments.pdf
Summary Plan Description - Rules & Regs - Amendments (Español).pdf
| Annuity |
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Application for Withdrawal.pdf
Application for Withdrawal (Español).pdf
Direct Deposit Election Form.pdf
IRS Form W-4P - Withholding Certificate for Pension or Annuity Payments.pdf
Notice to Interested Parties
Self Direct Annuity Class List.pdf
Self-Direct Transfer Form
Self-Direct Transfer Form - Return Monies to the Trustee-Directed Account
Summary Plan Description - Rules & Regs.pdf
Summary Plan Description - Rules & Regs (Español) .pdf
| Northern California Carpenters 401(k) Plan |
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Announcement of Plan - Effective September 1, 2008
Announcement of Plan - Effective September 1, 2008 (Español)
Beneficiary Designation Form
Beneficiary Designation Form (Español)
Enrollment/Contribution Change Form
Enrollment/Contribution Change Form (Español)
Notice to Interested Parties
Safe Harbor Notice
Summary Plan Description - Rules & Regs
| Vacation |
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Early Withdrawal Application.pdf
Early Withdrawal Application (Español).pdf
Summary Plan Description - Rules & Regs - Amendments.pdf
Summary Plan Description - Rules & Regs - Amendments (Español).pdf
| General |
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Address Change Form.pdf
Address Change Form (Español).pdf
Beneficiary Designation Form
Beneficiary Designation Form (Español)
Bereavement Leave Claim Form for Mill Cabinet Employees
Check Stub Claim Form (Report Missing Hours)
Consent Form for Release of Information
Disability Packet.pdf
Disability Packet (Español).pdf
Enrollment Form.pdf
Enrollment Form (Español).pdf
Notice of Privacy Practices.pdf
Obtaining a HIPAA Privacy Notice & Women's Health & Cancer Rights.pdf
Reciprocity Request - Transferring Hours to Northern California
Summary Annual Reports (September 1, 2009 - August 31, 2010)
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