U 26 3 Form PDF Details

Understanding the intricacies of the U-26.3 form is crucial for businesses in New York State, particularly those involved in sectors deemed hazardous under workers' compensation laws. Essentially, this document serves as proof that a business has procured the necessary workers’ compensation insurance for its employees, aligning with regulations set forth by the New York State Workers' Compensation Law. The New York State Insurance Fund, the sole provider of the U-26.3 form, offers this certificate to businesses to affirm their compliance. Such documentation becomes indispensable prior to the issuance of any permits or the initiation of contracts, including purchase orders, ensuring that the business is adequately covered. The holder of the certificate typically is an entity requiring confirmation of coverage, such as The Research Foundation for The State University of New York in this instance. It's also notable that while the U-26.3 form specifically verifies coverage through the New York State Insurance Fund, equivalent forms like the C-105.2 are issued by all licensed workers' compensation carriers in New York. These measures underscore the state's commitment to safeguarding employees while providing clear and structured channels for employers to demonstrate their compliance with mandatory insurance coverage requirements.

QuestionAnswer
Form NameU 26 3 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform u 26 3, nysif workers comp certificate, workers comp form u 26 3, nysif form u26 3

Form Preview Example

U-26.3 - New York State Insurance Fund Certificate of Workers’ Compensation

Coverage

What is the U-26.3 form?

Who provides the U-26.3 form?

Why it is needed?

When is it needed?

Who is the certificate holder?

Acceptable proof that the business has workers’ compensation coverage through the New York State Insurance Fund. The U-26.3 is only available through from the New York State Insurance Fund.* To establish proof that a business has secured workers’ compensation insurance coverage for all its employees.

Prior to any permit being issued or any contract, including purchase orders, being entered into for work

The Research Foundation for The State

University of New York

Who are the additional insureds?

N/A

*The U-26.3 can be obtained from any Business Office of the New York State Insurance Fund.

Workers’ compensation insurance is required for a business in which employees are engaged in hazardous employment as defined under article 1, section 3 of the New York State Workers’ Compensation law.

The Workers' Compensation Law requires employers to post Form C-105, Notice of Compliance - Workers’ Compensation Law, in all business locations. Employers involved in moving household goods or furniture and/or employers who have no established business locations for employees are required to post a Notice of Compliance, C-105.1, in vehicles they own or operate. The C-105 and the C-105.1 can be obtained from the State Insurance Fund and was also provided in the renewal information package that employers receive.

All NYS licensed workers’ compensation carriers issue the C-105.2, Certificate of NYS Workers’ Compensation Insurance Coverage, which is equivalent to the U-26.3 New York State Insurance Fund Certificate of Workers’ Compensation Coverage.

The next page provides a sample of a U-26.3 - New York State Insurance Fund Certificate of Workers’ Compensation Coverage.

New York State Insurance Fund

Workers' Compensation & Disability Benefits Specialists Since 1914

199 CHURCH STREET, NEW YORK, N.Y. 10007-1100

Phone: (888) 997-3863

CERTIFICATE OF WORKERS' COMPENSATION INSURANCE

Л Л Л Л Л Л

POLICYHOLDER

 

CERTIFICATE HOLDER

 

 

 

STATE UNIVERSITY OF NEW YORK @

 

 

 

ALBAYATTN:'

 

 

 

1400 WASHINGTON AVENUE

 

 

 

ALBANY NY 12222

 

POLICY NUMBER

CERTIFICATE NUMBER

PERIOD COVERED BY THIS CERTIFICATE

DATE

 

 

01/01/2009 TO 05/01/2010

1/8/2009

THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY N0.2058 840-6 UNTIL 05/01/2010, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS’ COMPENSATION UNDER THE NEW YORK WORKERS’ COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW.

IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 05/01/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE,

10DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW

YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE.

THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY..

NEW YORK STATE INSURANCE FUND

 

DIRECTOR,INSURANCE FUND UNDERWRITING

 

This certificate can be validated on our web site at https://www.nysif.com/cert/certval .asp or by calling (888) 875-5790

 

VALIDATION NUMBER: 107031806

U-26 3

0/CD23592-21/94

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