DISABILITY BENEFITS REQUIREMENTS. To assist the State of New York and municipal entities in enforcing WCL Section 220(8), a business entity (the Firm) seeking to enter into a contract with a municipality (the XXXXX) must provide one of the following forms to the municipal entity it is entering into a contract with. The Firm should contact their insurance agent to obtain acceptable proof of DB Insurance Coverage: • Form DB-120.1 – “Certificate of Insurance Coverage Under the NYS Disability Benefits Law” or • Form DB-155 – “Compliance with Disability Benefits Law” issued by the Self-Insurance Office of the Workers’ Compensation Board if the Firm is self-insured. If the Firm is not required to carry DB Insurance coverage, it must submit Form CE-200, “Certificate of Attestation of Exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage.” This form and the instructions for completing it are available at xxxx://xxx.xxx.xx.xxx
DISABILITY BENEFITS REQUIREMENTS. To assist the State of New York and the Owner in enforcing WCL Section 220(8), business entities (the Producer) seeking to enter into contract with the Owner MUST provide ONE of the following forms to the Owner: • Form DB-120.1 – “Certificate of Insurance Coverage Under the NYS Disability Benefits Law” or • Form DB-155 – “Compliance with Disability Benefits Law” issued by the Self-Insurance Office of the Workers’ Compensation Board if the Vendor is self-insured. If the Vendor is not required to carry DB Insurance coverage, it must submit Form CE-200, “Certificate of Attestation of Exemption” from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage. This form and the instructions for completing it are available at xxxx://xxx.xxx.xx.xxx
DISABILITY BENEFITS REQUIREMENTS. To assist the State of New York and municipal entities in enforcing WCL Section 220(8), the Parties must provide one of the following forms: • Form DB-120.1 – “Certificate of Insurance Coverage Under the NYS Disability Benefits Law” or • Form DB-155 – “Compliance with Disability Benefits Law” issued by the Self- Insurance Office of the Workers’ Compensation Board if the Firm is self-insured. If the Party is not required to carry DB Insurance coverage, it must submit Form CE-200, “Certificate of Attestation of Exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage.” This form and the instructions for completing it are available at xxxx://xxx.xxx.xx.xxx
DISABILITY BENEFITS REQUIREMENTS. To assist the State of New York and municipal entities in enforcing WCL Section 220(8), business entities seeking to enter into contract with municipalities MUST provide ONE of the following forms to the government entity (the lender) entering into a contract: IF THE PARTY IS REQUIRED TO CARRY COVERAGE AND HAS AN OUTSIDE CARRIER, submit
DISABILITY BENEFITS REQUIREMENTS. To assist the State of New York and municipal entities in enforcing WCL Section 220(8), a business entity (the Producer) seeking to enter into a contract with CHHS must provide one of the following forms to the municipal entity with which it is entering into a contract. The Producer should contact their insurance agent to obtain acceptable proof of DB Insurance Coverage: • Form DB-120.1 – “Certificate of Insurance Coverage Under the NYS Disability Benefits Law” or • Form DB-155 – “Compliance with Disability Benefits Law” issued by the Self-Insurance Office of the Workers’ Compensation Board if the Producer is self-insured. If the Producer is not required to carry DB Insurance coverage, it must submit Form CE-200, “Certificate of Attestation of Exemption” from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage. This form and the instructions for completing it are available at xxxx://xxx.xxx.xx.xxx
