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Dbpr el 4522-2026

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  1. Click ‘Get Form’ to open the dbpr el 4522 in our editor.
  2. Begin by certifying that you have made due inquiry of your employee leasing company’s records. This section requires you to confirm compliance with Florida Administrative Code.
  3. Fill in the percentage of leased employees covered by workers' compensation through various methods. For each method (a, b, c), provide the required percentages and details such as carrier names and policy numbers.
  4. In the section regarding clients utilizing their own workers’ compensation policies, list all relevant client names, effective dates, expiration dates, and policy numbers.
  5. Ensure that all controlling persons (CEO, CFO, Chairman) sign and print their names at the bottom of the form to validate the information provided.

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license florida company

Fla. Admin. Code Ann. R. 61G7-10.0014 - Requirements for

This statement shall be made on Board Form DBPR EL-4522, Quarterly Compliance Form effective July 2008, incorporated herein by reference and available at

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