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Vendors

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Vendor Name

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Enrollment Verification

Vendor Info
General Liability
Automobile
Umbrella/Excess
Workers' Compensation

Workers' Compensation Exemption

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.

Owner's Statement:
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.

In which states are you exempt for carrying Workers' Compensation Insurance
The name of the proprietor, partner, or owner.
Background Screen

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W9 Correct?

LATEST ERRORS IF ANY WILL APPEAR HERE

Workers' Comp Double Check

I have verified this is correct.

I have verified that the WC Agent's email address is cois@netvendor.net.

I have verified this unless otherwise approved (eg. Hartford, USAA, see list).
Property Compliance Verification

I have verified this is correct.
Liability Category Selected

I have verified this is correct.

Background Check

Owner Number
Government ID Override OR Tax ID if Owner #2 or #3
First Name *
Middle Int.
Last Name *
Birth Month *
Birth Day *
Birth Year *
Address *
City *
State *
Zip *

COMPLETING & Saving this ticket will automatically run a background check. If it fails, it will appear in this queue.

TinCheck Verification

Name *
Tax Id

COMPLETING & Saving this ticket will automatically run a tin check. If it fails, it will appear in this queue.

Email Failure Verification

General Liabiliy *
Automobile *
Umbrella/Excess *
Workers' Comp *
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This will place a reminder in this queue for a follow up two days from now.

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Vendors that are sub-accounts can ONLY join subscriptions that are already held by their Parent Vendor Account. If no subscriptions are available, the parent vendor account needs to signup with that company first.

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This will change all of the permissions for all NON-PM Admin Master user for this client.
If you need to change only several users, please use the SiteAdmin > Users interface.

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Property Address City State Zip
Workers' Comp

Workers' Compensation Exemption

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.

Owner's Statement:
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.

You can choose multiples states by holding shift or control key.
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Provide needed insurance information

Important: You must supply a valid insurance agent email address for each of your producers. NetVendor uses this email address to send your agent(s) the insurance certificate request.

General liability
Auto
Workers' Compensation
Does vendor carry Workers' Compensation insurance?

Workers' Compensation exemption

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.

Owner's Statement:
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.

Umbrella
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