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Click ‘Get Form’ to open the c105 2 form in the editor.
Begin by entering your license/registration number at the top of the form. Ensure this matches Department records for accuracy.
Fill in your business name and address, making sure they align with what is on file with the Department.
In the Certificate Holder box, input 'New York City Department of Buildings, Attn: Licensing Unit, 280 Broadway, 6th Floor, New York, NY 10007'.
Provide your insurance producer's business name, location, and office phone number as required.
Ensure all information is typed; handwritten corrections are not accepted. Review for completeness before submission.

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What is the NY C105 form?

New York Required Postings Workers Compensation Insurance Notice of Compliance (Form C-105) If necessary, contact EMPLOYERS or your licensed New York insurance agent. Anti-Fraud Notice (English and Spanish)

Who is exempt from workers compensation in NY?

However, there are a few limited exemptions. Sole proprietors with zero employees dont need workers comp insurance coverage. Neither do out-of-state businesses with no physical operations in New York.

What is the most common workers compensation claim?

7 Common Workers Compensation Claim Injuries Lacerations. Deep cuts or tears in skin or flesh. Sprains and strains. Sprains are stretched or torn ligaments, while strains are stretched or torn muscles and tendons. Contusions. Burns. Eye Injuries. Fractures. Cumulative or Continuous Trauma.

What is the penalty for not having workers compensation in New York?

Subsequent violations can be considered a Class D Felony for all employers and may result in additional fines not less than $10,000.00 but no more than $50,000.00. Your Business May Be Closed: Under Section 141-a of the Law, the Board may issue a Stop Work Order to a non-compliant business.