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[DOCX File]TFC | Texas Facilities Commission
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all employers must provide evidence of compliance with the insurance requirements of the texas workers’ compensation act. Generally, an employer with one or more employees carries workers’ compensation insurance to cover those employees or elects coverage through self-insurance as permitted by Texas Labor Code, Section 406.003.
workers compensation exemption form

[DOC File]AFFIDAVIT OF EXEMPTION
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Religious exemption. under the Workers’ Compensation Law. All employees of contractor are exempt from workers’ compensation insurance (attach copies of religious exemption letter for all employees). _____ Signature of Applicant Date. WV CODE §21-11-10. Prerequisites to obtaining building permit/ mandatory written contracts. ...
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[DOCX File]SOLE PROPRIETOR EXCLUSION FORM
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For workers’ compensation purposes our company is required to maintain verification regarding workers’ compensation coverage for all of our independent contractors. You must provide the following information, if you: are a sole proprietor not qualifying as an “employer” under the Michigan Workers’ Disability Compensation Act, * and
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[DOCX File]STATE OF ALASKA
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The application for self-insurance must be accompanied by a security deposit in the form of an irrevocable letter of credit from a financial institution authorized to conduct business in Alaska under AS 06.01.010-06.40.190, with the State of Alaska, Department of Labor …
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[DOC File]Sample Written Program - Texas
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Texas Department of Insurance, Division of Workers’ Compensation. Publication No. HS03-006A(01-06) ... This exemption applies only while the specimens remain in the facility. If the employer chooses to use this exemption, it should be stated here. ... (as per OSHA Letter of Interpretation, November 1, 2000). All employees who decline the ...
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[DOCX File]Sole Proprietor Waiver - Arizona
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The following is a written waiver under the compulsory Workers' Compensation laws of the State of Arizona, A.R.S. § 23-901 (et. seq.), and specifically, A.R.S. § 23-961(P), that provides that a Sole Proprietor may waive his/her rights to Workers' Compensation coverage and benefits.
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[DOC File]Workers’ Compensation Insurance Affidavit
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____ Religious exemption under Workers’ Compensation Law. All employees of contractor are exempt from workers’ compensation insurance. (Attach copies of religious exemption letters for all employees). ____ Use this form when applicable to part “C” on the workers’ compensation form.
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[DOCX File]LIFE, ACCIDENT AND HEALTH INSURERS
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Mar 29, 2021 · For insurers or reinsurers authorized to reinsure the injury, disablement, or death portions of workers’ compensation policies that wish to be on the Published List , pursuant to California Insurance Code Section 11691.3, please submit signed form to:
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[DOC File]West Virginia Insurance Commission
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An employer is not entitled to a letter of exemption from West Virginia workers’ compensation coverage unless it meets one of the specific exemptions as set forth in W. Va. Code § 23-2-1(b)(1) through (8), or otherwise proves that the employer is exempt from West Virginia workers’ compensation laws because it does not fall under the ...
workers compensation exemption form

[DOCX File]ATTACHMENT 6: CONTRACT INSURANCE commitment LETTER
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This letter and the following section define the contractually-required insurance coverages. ... Workers Compensation, Employers Liability, and Disability Benefits as required by New York State Law: ... Failure to provide proper proof of such coverage or a legal exemption will result in a rejection of this Lease. Therefore, prior to award of ...
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Letter of exemption workers compensation