The Department accepts the following forms:
General Liability
- Acord 25 (2009/01) - Certificate of Liability Insurance
- Acord 25 (2009/09) - Certificate of Liability Insurance
- Acord 25 (2010/05) – Certificate of Liability Insurance
Workers' Compensation
- U26.3 – Certificate of Workers’ Compensation Ins (NYS Insurance Fund only)
- C105.2 (9/07) – Certificate of Workers’ Compensation Insurance
- GSI 105.2 (2/02) – Certificate of Participation in Workers’ Compensation
Disability
- DB 120.1 (5/06) – Certificate of Compliance with Disability Benefits Law
Affidavit of Exemption from WC and Disability
- CE-200 – Certificate of Attestation of Exemption from New York State Workers’ Compensation and/or Disability Benefits Insurance Coverage