Db 120 1 2026

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The DB-120.1 form is a Certificate of Insurance Coverage required under the New York State Disability Benefits Law, which employers must provide to prove they have secured disability benefits insurance for their employees. This form is completed by a licensed NYS insurance carrier or agent and is necessary before permits or contracts are issued for work. It ensures compliance with state law, particularly for businesses employing individuals in New York for over 30 days in a calendar year.

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Click ‘Get Form’ to open the DB-120.1 in the editor.
Begin by entering the name of the business that has secured disability benefits insurance coverage in the designated field.
Next, provide the certificate holder's information, which typically includes their name and contact details.
In the section for additional insureds, list any other parties that should be covered under this insurance policy.
Ensure you include the insurance carrier's details, including their name and A.M. Best rating, confirming it meets the required 'A-' standard.
Review all entered information for accuracy before saving your changes and exporting or sharing the completed form.

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db 120 1

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