Get Facility 222.doc 2020-2025

This guide is designed to assist users in accurately completing the Facility 222.doc, a crucial document for independent contractors. By following the steps outlined below, individuals will confidently navigate each section of the form online.

Follow the steps to complete and submit your form accurately.

1. Press the ‘Get Form’ button to access the Facility 222.doc and open it in your online editing tool.
2. In the Policyholder Name section, enter the name of the policyholder for whom the form is being filled out. Select the appropriate type of entity you operate as by marking the corresponding box for Sole Proprietor, Partnership, Corporation, or Limited Liability Company. If you have filed a Doing Business As (DBA), remember to attach a copy.
3. Describe the type of work you perform in the designated field. Be clear and concise to ensure accurate classification.
4. Indicate whether you hire employees or casual laborers to assist with work for the policyholder. Select 'Yes' or 'No', and if you answer 'Yes', specify the number hired and attach a Certificate of Workers' Compensation Insurance.
5. Answer if you hire subcontractors for work related to the policyholder by selecting 'Yes' or 'No'. If 'Yes', be prepared to provide additional information.
6. State whether you have General Liability coverage by selecting 'Yes' or 'No'. If 'Yes', you must attach a Certificate of General Liability Insurance.
7. To validate your status as an independent contractor, indicate if you do not exclusively depend on payments from the policyholder. List any general contractors or clients you have worked with in the past twelve months, including their name, city, and telephone number.
8. Acknowledge your status as a sole proprietor by confirming your understanding that you are not covered by or subject to the Workers’ Disability Compensation Act.
9. Certify that the information provided is true and complete. Sign the form, fill in your phone number, date, and required email address.
10. Once all sections are completed, you should have options to save your changes, download, print, or share the completed form.

Complete your Facility 222.doc online today for a streamlined experience.