Feel free to use this format. It is what we use in Alabama.....
WORKERS COMENSATION WAIVER
I, Subcontractor Name, sole proprietor of
_________________________________________________,
with no employees and as principal owner and operator elect not to nor am I required to obtain or hold workers compensation insurance within the state of Alabama.
Furthermore, I hereby agree to indemnify and hold harmless Prime Contractor Name, Customer Name, and all of their respective officers, directors, employees and subcontractors in the event of a work related injury, accident, illness or disease.
I also understand and agree that I am required by law to obtain the proper workers compensation and liability insurances. If I or my Company adds or hire employees, I or my Company will obtain said insurances prior to allowing any employee to work for me or my Company, or assist me or my Company in any work, or accompany me to any worksite for the above named companies and all of their respective officers, directors, employees and subcontractors.
Regards,
Chris
Sample Waiver form
Member #: 10799
Registered: 1996-2001
Posted:
22
Name:
richard w. vallauri
Name:
Richard W. Vallauri
Company:
rwv enterprises inc
Occupation:
owner/op
Location:
gulf breeze fl
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