Click on the titles below to get to the forms.
OBTAINING THE PROPER PERMITS AND REQUIRED DOCUMENTS
Do you need to provide your local county office proof of coverage for
New York State Workers’ Compensation and Disability to file your permits?
Contact the Risk Management and Human Resources office to request the forms.
The Workers' Compensation forms are requested from New York State Office of Compliance.
The Disability forms are requested from our Disability Insurance Carrier, Sun Life Financial.
These forms can take up to 2 weeks to come in from the State.
PLEASE PLAN AHEAD!
DB-155 – Proof of Disability Coverage - Contact Human Resources
Call Amanda Kolb or Megan Birardi at 315-422-9091 or
email email@example.com to request the Disability documents for you.
SI-12 – Proof of Workers’ Compensation Coverage
Call Sue Wuerthner at 315-470-1495
or email Sue at firstname.lastname@example.org to request the Workers Compensation coverage documents for you.