Waitsfield Workers Comp Hold Harmless Form - Town of Waitsfield: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by entering your company name in the designated field at the top of the form. This identifies who is agreeing to the terms.
Fill in the date on which you are completing the form. This is important for record-keeping purposes.
In the 'Print Name' section, clearly write your full name as it appears on official documents.
Next, provide a witness signature in the appropriate field. This adds validity to your agreement.
Sign your name in the 'Sign Name' section to confirm your acceptance of the terms outlined in the agreement.
Proceed to complete the Non-Employee Work Agreement section by filling out your business name and address accurately.
Indicate whether you have procured Workers’ Compensation Insurance and provide details if applicable, including carrier information and effective dates.

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