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Get CO OCIP-S(1) 2014-2024

_____________________________________________________________ Your Company was hired by: % Self-Performed Work: _____________________________________________________________________________________________ ______________________________ Contract Amount: $ ___________________________________ I. Workers’ Compensation and Employers Liability Labor Classification WC Class Code Estimated Man Hours WC Rate (Per $100 of Payroll) Estimated Payroll Premium Policy Deductible Subtotal: Increa.

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