Common use of Proof of Compliance with Disability Benefits Coverage Requirements Clause in Contracts

Proof of Compliance with Disability Benefits Coverage Requirements. 1. In order to provide proof of compliance with the requirements of the New York State Workers’ Compensation Law pertaining to disability benefits, a contractor shall: a. Be legally exempt from obtaining disability benefits coverage; or b. Obtain such coverage from an insurance carrier; or c. Be a Board-approved self-insured employer. 2. A Contractor seeking to enter into a contract with the State of New York shall provide one of the following forms to the Office of General Services before this Piggyback Contract can be executed by the Commissioner. a. Form CE-200, Certificate of Attestation for New York Entities With No Employees and Certain Out of State Entities, That New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage is Not Required, which is available on the Workers’ Compensation Board’s website (▇▇▇.▇▇▇.▇▇.▇▇▇). b. Form DB-120.1, Certificate of Disability Benefits Insurance. Contractor must request its business insurance carrier to send this form to the New York State Office of General Services; or c. Form DB-155, Certificate of Disability Benefits Self-Insurance. The Contractor must call the Board’s Self-Insurance Office at ▇▇▇-▇▇▇-▇▇▇▇ to obtain this form.

Proof of Compliance with Disability Benefits Coverage Requirements. 1. In order to provide proof of compliance with the requirements of the New York State Workers’ Compensation Law pertaining to disability benefits, a contractor shall: a. Be legally exempt from obtaining disability benefits coverage; or b. Obtain such coverage from an insurance carrier; or c. Be a Board-approved self-insured employer. 2. A Contractor seeking to enter into a contract with the State of New York shall provide one of the following forms to the Office of General Services before this Piggyback Contract can be executed by the Commissioner. a. Form CE-200, Certificate of Attestation for New York Entities With No Employees and Certain Out of State Entities, That New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage is Not Required, which is available on the Workers’ Compensation Board’s website (▇▇▇.▇▇▇.▇▇.▇▇▇). b. Form DB-120.1, Certificate of Disability Benefits Insurance. Contractor must request its business insurance carrier to send this form to the New York State Office of General Services; or c. Form DB-155, Certificate of Disability Benefits Self-Insurance. The Contractor must call the Board’s Self-Insurance Office at ▇▇▇518-▇▇▇-▇▇▇▇ 402- 0247 to obtain this form.