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Please read and sign the below if you have no employees and are the sole proprietor or partner of a small business.
The legal requirements regarding the purchase of Workers' Compensation insurance are different from state to state.
Although we suggest owners and executive officers to elect coverage for Workers' Compensation coverage, generally,
state laws do not require the these businesses to be covered by Workers' Compensation insurance. Please review your specific state laws.
By signing below, I declare my company is exempt from carrying Workers' Compensation insurance in the below state(s),
because I do not have any employees as that term is defined by the Workers' Compensation statutes and regulations in the state or states below.
All of the work performed in my business is performed by the proprietor, owners, partners or executive officers.
I have elected not to cover the proprietor, owners, partners or executive officers with Workers' Compensation insurance.
This decision is made in full compliance with the Workers' Compensation laws and regulations of the below state(s).
If I should hire any employee(s), then I will elect to purchase Workers' Compensation insurance to cover my employees
and will provide a certificate of insurance to .
I hereby understand and agree that if I am injured while working any job, I will not be covered for any injury under
Workers' Compensation insurance policies. In addition, I waive all rights of action against
and the owner or owners of the property and/or project.
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