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Workers Comp Waiver Form
"Need a Workers Comp Waiver Form for our technology consulting firm in California, to be used with independent software developers starting March 2025, with specific mention of alternative private insurance coverage requirements."
1. Worker Information: Full legal name, contact information, and employment status of the worker
2. Employer Information: Company details, registration information, and business address
3. Waiver Declaration: Clear statement of workers' compensation coverage waiver
4. Acknowledgment of Rights: Worker's acknowledgment of understanding their rights and the implications of the waiver
5. Duration: Period for which the waiver is valid
1. Alternative Insurance Coverage: Details of any alternative insurance coverage, used when worker has private insurance
2. Project-Specific Details: Information about specific project or work scope
3. State-Specific Declarations: Additional declarations required by specific states
1. Proof of Alternative Insurance: Documentation of alternative insurance coverage
2. State-Required Forms: Any additional state-mandated forms or documentation
3. Risk Acknowledgment: Detailed list of risks associated with waiving workers' compensation coverage
Authors
Waiver
Effective Date
Independent Contractor
Employer
Work Site
Alternative Insurance Coverage
Coverage Period
Services
State Workers' Compensation Act
Work-Related Injury
Occupational Disease
Benefits
Contract Work
Project
Compensation
Insurance Provider
Governing Law
Jurisdiction
Notice Period
Acknowledgment
Professional Services
Risk Assumption
Consideration
Claims
Voluntary Waiver
Assumption of Risk
Alternative Insurance Coverage
Term and Duration
Governing Law
Revocation Rights
State-Specific Compliance
Scope of Work
Representation and Warranties
Indemnification
Notice Requirements
Amendment and Modification
Severability
Entire Agreement
Acknowledgment of Independent Contractor Status
Release of Claims
Insurance Requirements
Safety Compliance
Execution and Delivery
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