Get Dbpr El 4522 2020-2025

This guide provides a clear and supportive approach to completing the Dbpr El 4522, the Quarterly Compliance Form for employee leasing companies. By following these steps, users can confidently fill out the form online.

Follow the steps to complete the Dbpr El 4522 online.

1. Click ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by reviewing the introductory statement on the form that certifies the inquiry made regarding the workers' compensation coverage for all leased employees.
3. In the next section, provide the percentage of leased employees covered through a contractual relationship with an admitted insurance carrier, and enter the name and policy number of the carrier.
4. Specify the percentage of employees covered through a lawful plan of self-insurance maintained by your employee leasing company or group.
5. Indicate the percentage of employees that are covered by clients through an admitted insurance carrier or self-insurance, and provide details of all clients utilizing their own coverage, including names, policy details, and effective dates.
6. Confirm that the written employee leasing contract allows for this arrangement and check that your company is named as a certificate holder on the client's policy.
7. If there are other workers' compensation arrangements, detail those and include the corresponding percentage coverage.
8. In the last section, ensure that the controlling persons, including the Chief Executive Officer, Chief Financial Officer, and Chairman of the Board, sign and print their names to validate the document.
9. Once all information has been filled out, review the entire document for accuracy. Save your changes, and then proceed to download, print, or share the completed form as needed.

Complete the Dbpr El 4522 online today for your employee leasing company.