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Basic Application
Workers' Compensation Application (Florida) Acord 130 FL Normal
Instructions for Completing ACORD 130 FL Custom Normal
WC Persons Inc/Excl, Prior Carrier Info & Loss History WC Acord Normal
Acord 130 Rating Information Acord 130 Rating Normal


Applications for all Business Types - FWCJUA
Addendum to Acord 130 FL ACORD 133 FL Normal
Instructions for Completing ACORD 133 FL Acord 134 FL Normal
Applicant's Affidavit FWCJUA Normal
Assessable Policy Endorsement FWCJUA Normal
Tier 3 Acknowledgment Custom Normal
Bankruptcy Questionnaire Custom Normal
Employee Leasing Questionnaire Custom Normal
Employer's Affidavit FWCJUA Normal
Employee Leasing Affidavit Custom Normal
Employment and Wage Information Release Agreement FWCJUA Normal
UCT-6 Questionnaire Custom Normal
Workplace Safety Program Premium Credit NCCI Safety 09-03 Normal
Subcontractor WC Coverage Requirements Acknowledgment Custom Normal
Leased Employee Affidavit FWCJUA Normal
Subcontractor Leased Employee Affidavit Custom Normal


Special Application for Contractors - FWCJUA
Contractor's Supplemental Application FWCJUA Normal


Employee Leasing Applications - FWCJUA
Acknowledgment by Client of Continued Coverage Under MCP FWCJUA Normal
Acknowledgment of Multiple Coordinated Policy FWCJUA Normal
Supplemental Employee Leasing Application FWCJUA Normal


Special Application for Truckers - FWCJUA
Trucker's Supplemental Application FWCJUA Normal


Special Applications - FWCJUA
Confidential Request for Information ERM-14 Normal
Instructions for Completing the ERM-14 NCCI Normal
"If Any" Acknowledgment form FWCJUA Normal
Deductible Application $2,500 FWCJUA Normal
Subcontractor's - Data Custom Normal
Paychex Service Agreement FWCJUA Normal
Payroll Services Application FWCJUA Normal
Client Reporting Form FWCJUA Normal


General Information - FWCJUA
Commission Schedule FWCJUA Normal
Rating Tiers FWCJUA Normal
FWCJUA & St Paul Travelers Contact Information FWCJUA Normal
Other States Coverage Rules FWCJUA Normal
Policy Cancellation Procedure FWCJUA Normal
St Paul Travelers Claims Reporting Notice St Paul Travelers Normal
Post Binding Requirements of the FWCJUA Custom Normal
Certificate of Insurance - St Paul Travelers Request Procedure Custom Normal
Premium Audit Q and A Custom Normal
FWCJUA Application Checklist Custom Normal
FWCJUA Payment Options FWCJUA Normal
WC Anniversary Rating Date (ARD) rule NCCI Normal


Florida Exemption Applications
Florida Notice of Revocation of Election to be Exempt Acord 172 FL Normal
Florida Notice of Election to be Exempt Acord 173 FL Normal
Florida Notice of Election of Coverage Acord 171 FL Normal
Florida Revocation of Election of Coverage Acord 174 FL Normal
Rules on Exclusions and Wage Limits in a Florida Policy Custom Normal
Exemption Application Problems Frequently Encountered DFS Normal
Proprietor/partner Division of Compliance auto exempt letter Custom Normal


Exemption Applications
Notice of Election to be Exempt DWC 250 Normal
Notice of Election to be exempt application instructions DFS Normal
Notice of Revocation of Election to be Exempt DWC-250-R Normal
Notice of Election of Coverage DWC-251 Normal
Revocation of Election of Coverage DWC-251-R Normal


Credits
Deductible Credit Election Custom Normal
Drug Free Premium Credit 09-01 Normal
FCCPAP Credit NCCI Normal
Workplace Safety Program Premium Credit NCCI Normal


General
Cancellation Request Form Acord 35 Normal
Workers' Compensation Application (all states except Florida) Acord 130 Normal
Agent Change of Record Acord 36 Normal
FWCJUA Agent Change of Record Procedure Custom Normal
Certificate of Insurance Acord 25 Normal
Addendum to Acord 130 ACORD 133 Normal
Consent to Rate Custom Normal
Monthly Change Sheet ACORD 175 FL Normal
NCCI Physical Inspection Order Form NCCI Normal
Loss History Affidavitt Custom Normal
Waiver of Subrogation Application and Checklist Custom Normal
Waiver of Subrogration - definition & examples Custom Normal
Injury or Illness - First Report DWC-1 Normal
Important Workers' Compensation Information for Claimants DFS Normal
Charge Back Credit Card Fee Florida Statutes Normal
Employment Eligibility Form Custom Normal
Premium Finance Rebates Unregulated Custom Normal


Premium Finance
Premium Finance Document Processing Custom Normal
Care Of Letter Custom Normal


Miscellaneous
Florida Standard Market Rates 1/1/2008 NCCI Normal
FWCJUA Rates 2008 Custom Normal
NCCI Workers' Compensation States Custom Normal
Divisible Class Code Rules NCCI Normal
Foreign Corporation Registration Division of Corporations Normal
Legal Structure Types Custom Normal
Sample Stock Certificate Custom Normal
Non-Compliance Penalty Worksheet Custom Normal
Credit Card Payment Authorization Form Custom Normal
Independent Contractor Status Affidavit Custom Normal
Independent Contractor Test Florida Statutes Normal
Bureau of Compliance Offices DFS Normal
List of Common Submission Errors DFS Normal
Request for Taxpayer Identification Number W-9 Normal
Lead Fees Custom Normal