Common use of DISABILITY BENEFITS REQUIREMENTS Clause in Contracts

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 the Owner County in enforcing WCL Section 220(8), business entities (the Producer) seeking to enter into contract with the Owner County MUST provide ONE of the following forms to the OwnerCounty: • 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 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