; Adam Bello, County Executive

Workers' Compensation/Disability Compliance Documentation

The Monroe County Department of Public Health is required to ensure that permit applicants are in compliance with New York State Workers' Compensation/Disability requirements at the time a permit is issued.  ACORD forms are not acceptable documentation.  

Links to examples of the various forms: 

Examples of acceptable Workers' Compensation certificates:

Examples of acceptable Disability Coverage documentation:
Example of an exemption from Workers' Compensation, Disability, or both Workers' Compensation and Disability:
Entities eligible for an exemption can request a Certificate of Attestation of Exemption through the Workers' Compensation website

For details about this requirement, see the NY Workers' Compensation Board's publication:

If you have questions, please contact the relevant program.

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