BOX OF STATEMENT THAT APPLIES
AGREEMENT TO ESTABLISH EMPLOYER- EMPLOYEE RELATIONSHIP FOR CERTAIN BUILDING AND CONSTRUCTION WORKERS
will withhold 
will not withhold the cost of workers' compensation insurance coverage from the Independent Contractor's contract price and that the Hiring Contractor will purchase workers' compensation insurance coverage for the Independent Contractor and the Independent Contractor's employees. Once this agreement is signed, for the purpose of providing workers' compensation insurance coverage, the Hiring Contractor will be the employer of the Independent Contractor and the Independent Contractor's employees. This agreement makes the Hiring Contractor the employer of the Independent Contractor and the Independent Contractor's employees only for the purposes of workers' compensation laws of Texas and for no other purpose.This PDF editor was designed to be as simple as possible. While you adhere to the next steps, the procedure for completing the dwc83 form document will be trouble-free.
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Write down the information in THIS DECLARATION TAKES EFFECT, If the Hiring Contractors workers, Hiring Contractors Affirmation, Federal Tax ID Number, Signature of Hiring Contractor, Date, Address Street, Printed Name of the Hiring, Address City State Zip, Independent Contractors Affirmation, Federal Tax ID Number, Signature of Independent, Date, Address Street, and Printed Name of the Independent.
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