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VENDOR WORKERS COMPENSATION WAIVER FORM We are required to maintain verification regarding workers compensation coverage for all of our vendors that are contracted to provide a service and to release the City of Romulus of any and all liability for injuries that may occur while conducting business on City of Romulus Property. Dated at on this day of Signed STATE OF MICHIGAN COUNTY OF On this day of before me personally appeared benefits as indicated under Michigan s Law....
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Vendor workers compensation waiver is a document that allows vendors to waive the requirement for workers compensation insurance coverage for themselves.
Vendors who do not have employees or are exempt from providing workers compensation coverage may be required to file a vendor workers compensation waiver.
To fill out a vendor workers compensation waiver, vendors must provide their business information, certify their exemption status, and sign the document.
The purpose of vendor workers compensation waiver is to waive the requirement for vendors to provide workers compensation coverage for themselves.
The vendor must report their business information, exemption status, and sign the waiver.
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