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How do I fill this out?
To fill out this form, ensure you have the required business information ready. Begin by inputting the legal name and address of the insured. Follow the prompts to complete all sections accurately.

How to fill out the New York Workers Compensation Insurance Certificate?
1
Gather all necessary business and insurance information.
2
Fill out the legal name and address of the insured.
3
Provide the details of the entity requesting the proof.
4
Input the insurance carrier information and policy details.
5
Sign and date the certificate as required.
Who needs the New York Workers Compensation Insurance Certificate?
1
Businesses operating in New York must submit proof of workers' compensation insurance.
2
Contractors engaged in public works projects need this for compliance.
3
Employers looking to obtain permits or licenses require this certificate.
4
Organizations hiring contractors may request this as part of their due diligence.
5
Self-employed individuals may need to provide this for specific projects.
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What are the instructions for submitting this form?
To submit this form, ensure all fields are accurately filled and the document is signed. You can either email the completed certificate to the requesting entity, fax it to the provided number, or submit it through their online portal if available. For physical submissions, mail the document to the address specified by the entity.
What are the important dates for this form in 2024 and 2025?
For 2024, ensure you review your coverage by the policy expiration date on your certificate. Update the certificate annually to maintain compliance. Renewal notices may be sent by your insurance carrier for your policy effective dates.

What is the purpose of this form?
The purpose of this form is to provide official proof of workers' compensation insurance coverage as required by New York State law. It is crucial for businesses to demonstrate they have secured insurance for their employees in case of work-related injuries. This certificate is often necessary for obtaining permits, licenses, or entering into contracts.

Tell me about this form and its components and fields line-by-line.

- 1. Legal Name & Address of Insured: The official name and address of the business or individual insured.
- 2. Entity Requesting Proof: The name and address of the entity that requires proof of insurance.
- 3. Business Telephone Number: Contact number for the insured party.
- 4. Employer Registration Number: Unique identification number for workers' compensation purposes.
- 5. Insurance Carrier Name: The company providing the workers' compensation coverage.
- 6. Policy Number: The unique number assigned to the insurance policy.
- 7. Policy Effective Period: Duration for which the insurance policy is valid.
- 8. Signature: Authorized signature to verify the information provided.
What happens if I fail to submit this form?
If you fail to submit this form, you may face legal consequences and be unable to legally operate your business in New York. Without the certificate, you may not be eligible for certain permits and contracts. This could lead to potential penalties or business disruptions.
- Legal Penalties: Operating without required insurance documentation can lead to fines or legal action.
- Loss of Contracts: Contractors may not accept your bids if this certificate is not provided.
- Operational Delays: Failure to submit can cause delays in project commencement due to compliance issues.
- Insurance Coverage Gaps: Not having this certificate might lead to uninsured periods, risking employee coverage.
- Permit Denial: State and municipal departments may deny permits without proof of coverage.
How do I know when to use this form?

- 1. Applying for Business Licenses: Required when submitting applications for licenses to operate legally.
- 2. Bidding on Contracts: Necessary for contractors looking to bid on public and private projects.
- 3. Securing Permits: Mandatory for obtaining construction or operating permits in New York.
- 4. Engaging Contractors: Important when hiring subcontractors or other businesses to ensure coverage.
- 5. Compliance Audits: Often required during compliance checks by state agencies.
Frequently Asked Questions
How do I obtain this certificate?
You can obtain the Certificate of NYS Workers' Compensation Insurance Coverage from your insurance carrier.
Is there a fee to apply for this certificate?
Generally, there is no fee for the certificate, but verify with your insurance provider.
Can I edit the certificate after printing?
Yes, you can edit the PDF before finalizing it using PrintFriendly's editing tools.
What information do I need to fill out?
You will need your legal business name, insurance carrier details, and policy information.
How do I submit this certificate?
Submit the completed certificate to the entity requesting proof of coverage.
Is this certificate valid everywhere in New York?
Yes, this certificate is recognized statewide for various licensing and contracting purposes.
How long is this certificate valid?
The certificate is typically valid for one year unless stated otherwise.
What if my policy is canceled?
Your insurance carrier must notify certificate holders if your policy is canceled.
Can I get a copy of my submitted certificate?
You can download a copy of your certificate after submitting it using PrintFriendly.
What should I do if my details change?
If your business details change, you need to update the certificate accordingly.
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