Get IA Workers Compensation Waiver

WORKERS COMPENSATION WAIVER ALL EMPLOYERS MUST PROVIDE EVIDENCE OF COMPLIANCE WITH THE INSURANCE REQUIREMENTS OF THE IOWA WORKERS COMPENSATION as required by Iowa Code Chapters 85 through 87 17A and Chapter 876 of Iowa Code. An individual employer partner limited liability company member self-employed person OR corporate executive officer owning 25 or more of the common stock is not required to be covered but may elect to be covered if he/she is engaged in the business on a substantially full-time basis or is a qualifying corporate officer. If an individual employer etc. elects to be covered he/she must file written notice of such election with his/her current Workers Compensation insurer. If an individual employer etc. elects to be covered he/she must file written notice of such election with his/her current Workers Compensation insurer. Also every officer of a corporation other than those described above is considered to be an employee of the corporation. Non-profit corporate officers who receive annual compensation of one thousand dollars or less from the corporation are not considered employees unless they elect to be covered. EACH BUSINESS SHOULD COMPLY WITH ONE OF THE FOLLOWING OPTIONS. 1 Obtain Workers Compensation Insurance. This is required if 1 the business has any employees 2 the business is a sole proprietorship partnership or limited liability company and the individual owner partner or limited liability company member has elected to be covered under the Iowa Workers Compensation Act or 3 the business is a corporation and any of the executive officers who own 25 or more of the common stock has elected to be covered under the Iowa Workers Compensation Act. 2 A signed statement see below that the business is a sole proprietor partnership limited liability company or corporation that has no employees and that no individual owner partner limited liability company member or eligible corporate officer has elected to be covered under the Iowa Workers Compensation Act. BUSINESS NAME PLEASE SIGN THE STATEMENT THAT APPLIES TO YOUR BUSINESS. I am a sole proprietorship. I have no employees and I as an individual employer have not elected to be covered under the Iowa Workers Compensation Act. Also every officer of a corporation other than those described above is considered to be an employee of the corporation. Non-profit corporate officers who receive annual compensation of one thousand dollars or less from the corporation are not considered employees unless they elect to be covered. EACH BUSINESS SHOULD COMPLY WITH ONE OF THE FOLLOWING OPTIONS. 1 Obtain Workers Compensation Insurance. This is required if 1 the business has any employees 2 the business is a sole proprietorship partnership or limited liability company and the individual owner partner or limited liability company member has elected to be covered under the Iowa Workers Compensation Act or 3 the business is a corporation and any of the executive officers who own 25 or more of the common stock has elected to be covered under the Iowa Workers Compensation Act. 2 A signed statement see below that the business is a sole proprietor partnership limited liability company or corporation that has no employees and that no individual owner partner limited liability company member or eligible corporate officer has elected to be covered under the Iowa Workers Compensation Act. BUSINESS NAME PLEASE SIGN THE STATEMENT THAT APPLIES TO YOUR BUSINESS. I am a sole proprietorship. I have no employees and I as an individual employer have not elected to be covered under the Iowa Workers Compensation Act. Signature of SOLE OWNER Date We are a partnership we have no employees and we as partners have not elected to be covered under the Iowa Workers Compensation Act. Generally an employer with one or more employees must carry Workers Compensation insurance to cover those employees. An individual employer partner limited liability company member self-employed person OR corporate executive officer owning 25 or more of the common stock is not required to be covered but may elect to be covered if he/she is engaged in the business on a substantially full-time basis or is a qualifying corporate officer. Signature of SOLE OWNER Date We are a partnership we have no employees and we as partners have not elected to be covered under the Iowa Workers Compensation Act. Signature of PARTNER We are a limited liability company we have no employees and we as limited liability company members have not elected to be covered under the Iowa Workers Compensation Act.