Get Dbpr El 4504 - Quarterly Report Form

Completing the DBPR EL 4504 Quarterly Report Form online is essential for compliance with Florida statutes. This guide provides a clear, step-by-step process to ensure accuracy and completeness in your submission.

Follow the steps to fill out the DBPR EL 4504 Quarterly Report Form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the designated online editor.
2. Indicate the appropriate quarter that your report is addressing by checking the corresponding box for either March 31, June 30, September 30, or December 31.
3. The CEO or an equivalent must read, sign, and date the section labeled 'CEO Statement' to verify compliance with health and employee benefit payments.
4. The CFO or an equivalent needs to sign and date the 'CFO Statement' and attach the current quarter's balance sheet and income statement.
5. Complete Page 3 of the form by listing all controlling persons of your company, detailing insurance plans provided to employees, and noting any disputed premiums for workers' compensation or unpaid payroll taxes.
6. Attach copies of any relevant workers' compensation certificates that cover leased employees for the reporting quarter, including notifications about cancellation, if applicable.
7. If necessary, complete and attach Form DBPR EL-4522, the 'Quarterly Compliance Form,' as specified by the rules under Florida Administrative Code.
8. Once all fields are completed and documents are attached, save your changes, and consider downloading, printing, or sharing the form as needed.

Take action now and complete your DBPR EL 4504 Quarterly Report Form online to stay compliant.