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  • Ny Db-850 2002

Get Ny Db-850 2002-2025

: Chair, Workers' Compensation Board _____________________________________________________________________________________, an insurance carrier authorized by the Superintendent of Insurance to write contracts insuring the obligations of employers pursuant to Section 211 of the Workers' Compensation Law, hereby applies under Section 360.1(b)(1) NYCRR for the acceptance of the attached insurance form, and requests assignment of an identifying number. 1. The attached form is: Policy Rider or En.

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DB-850 - Workers' Compensation Board - NY.gov
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SI-12 (7/23) Affidavit Certifying That Compensation Has Been Secured. Employers with Board-approved self-insurance for workers' compensation. Filed with the government agency issuing a permit, license, or contract. The SI-12 must be completed by the Board's Self-Insurance Office.

Workers' Comp Exemptions in New York. Sole-Proprietors included on workers' compensation coverage must use a minimum payroll amount of $45,500 and a maximum payroll amount of $137,800 for rating their overall workers' compensation cost.

Certificate of NYS Workers' Compensation Insurance. Reporting Proof of Coverage for Disability and Paid Family Leave Benefits. Certificates of NYS Disability and Paid Family Leave Insurance. Self-Insured Employers.

Workers' Compensation coverage is not required if the business is a one or two person owned corporation, with those individuals owning all of the stock and holding all offices of the corporation (each individual must hold an office and own at least one share of stock).

Failure to secure workers' compensation coverage for five or fewer employees within a 12-month period is a misdemeanor punishable by a fine of between $1,000 and $5,000.

Failure to secure the payment of compensation for more than five employees within a 12 month period shall constitute a class E felony punishable by a fine of not less than $5,000 nor more than $50,000 and is in addition to any other penalties otherwise provided by law.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232