State Compensation Insurance Fund
1010 Vaquero Circle, Suite 1171
Vacaville, CA 95688
Phone: (888) 724-3237
Public Records Office
Fax #: (707) 624-4596
Describe the information you are requesting. Be as specific as possible and include enough detail to assist us in locating the record(s).
Section B - Record(s) Requested
Company (if any ):
Public Records Act Request Form
This form is provided for your convenience but is not required to request records. Providing contact information
will allow us to reach you in the event we require additional information to fulfill your request.
Section A - Contact Information
Is this information being requested for pending or anticipated litigation in which State Fund may be a party?
Is this request for media purposes?
Section C -Additional Information (Providing the information in Section C is voluntary.)
SCIF e25005 (Rev. 08/11)