Business insurance insights
New York C-105.2: Workers’ Comp Proof for a Permit or Contract
Match your insurance arrangement to New York’s accepted proof form, then use a short request worksheet to collect the agency and policy details.
For a New York State or municipal permit, license or contract, a business using Form C-105.2 asks its workers’ compensation carrier to send the certificate to the government entity. A business insured through the State Insurance Fund uses U-26.3. Approved self-insurers and businesses legally exempt from coverage have different proof documents. The New York Workers’ Compensation Board lists the accepted forms and says ACORD forms are unacceptable proof under Workers’ Compensation Law Section 57.
Start with the agency’s request and your insurance arrangement. That identifies the document to obtain before you assemble the application.
Match the form to your coverage arrangement
The Board’s permit, license and contract guidance identifies these routes:
| Your arrangement | Proof document | Where to obtain it |
|---|---|---|
| Coverage from an insurance carrier | C-105.2 | Ask the carrier to send it to the government entity. |
| Coverage through the State Insurance Fund | U-26.3 | Request the Fund’s version of the certificate. |
| Approved individual self-insurance | SI-12 | Contact the Board’s Self-Insurance Office. |
| Approved group self-insurance | SIG-105.2 | Ask the group’s self-insurance administrator to send it. |
| Legal exemption from the coverage requirement | CE-200 | Follow the Board’s exemption instructions for the business’s actual circumstances. |
The Board says this proof requirement applies to original applications and renewals. It applies whether the government entity is commissioning the work or issuing the permit, license or contract.
For coverage background, see the workers’ compensation insurance guide. Keep the form request alongside the actual application so the agency name and project reference stay consistent.
Why a general certificate needs a separate check
Travelers describes a certificate of insurance as evidence of coverage at a particular time, summarizing details such as coverage types, limits and effective dates. It distinguishes that summary from the policy itself, which is the contractual coverage agreement.
For proof under Workers’ Compensation Law Section 57, the Board expressly excludes ACORD forms and lists the accepted alternatives above. Ask for the applicable form by number. If the agency’s request uses a different document name, ask it to clarify which accepted form it wants.
Prepare a proof request in one place
Use this worksheet when contacting the carrier or self-insurance administrator. These are practical information-gathering steps; the agency’s own submission instructions supply the destination and required format.
| Record from your application or policy | Question to resolve |
|---|---|
| Business name and policy number | Which insured business is applying? |
| Permit, license or contract reference | Which application should the agency match to this document? |
| Government entity and contact | Where should the issuer send the proof? |
| Policy effective and expiration dates | Which coverage period is relevant to the application? |
| Agency deadline and submission instructions | When and how must the agency receive it? |
After requesting the form, retain a copy and ask the agency to confirm receipt. Record any remaining question and who is handling it. The COI checklist provides another place to organize insurance-document questions.
Check an exemption against the Board’s rules
The Board limits CE-200 to showing a government agency that a business is exempt from New York workers’ compensation and/or disability and Paid Family Leave benefits insurance requirements. The Board prohibits using CE-200 to prove an exemption to another business or that business’s insurance carrier. For an out-of-state employer seeking a workers’ compensation exemption, its guidance requires all work for the permit, license or contract to take place outside New York, with no employees of that business working in the state. The Board directs businesses uncertain about their coverage obligation to its Bureau of Compliance. Read the exemption conditions in context.
Use the New York business insurance guide for the broader state context. If the application has prompted a wider review of your business’s insurance needs, the business insurance quiz can help organize that review.
Have a question about your own situation? Send it to PolicyBenchmark.
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This content is for informational purposes only and does not constitute insurance advice. Always consult with a licensed insurance professional before making coverage decisions.