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Dbpr el 4522-2025

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The document is a compliance form for employee leasing companies in Florida, certifying that all leased employees have the required workers' compensation coverage as per Florida Administrative Code Rule 61G7-10.0014. It outlines the methods of coverage, including insurance carrier relationships and self-insurance plans, and requires verification from controlling persons of the company regarding the accuracy of the information provided.

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Click ‘Get Form’ to open the dbpr el 4522 in the editor.
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.
Fill in the percentage of leased employees covered by workers' compensation through various methods outlined in the form. Be sure to specify details such as carrier names and policy numbers where applicable.
In the section regarding self-insurance, indicate the percentage of coverage and provide any necessary explanations for alternative arrangements.
Ensure all controlling persons, including the Chief Executive Officer, Chief Financial Officer, and Chairman of the Board, sign and print their names at the bottom of the form.

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2008	4.8 Satisfied (176 Votes)

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