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Division of Workers' Compensation
 

Insurance Coverage & Certification
 

Form

Description

Rejection of Coverage By Corporate Officers Or Member Of A Limited Liability Company

Form # WC43

 

Fillable  pdf MS Word

 

This form is used by corporate officers or members of a limited liability company to reject workers’ compensation insurance coverage.

Exclusion of Uncompensated Officials

Form # WC44

Fillable  pdf MS Word

 

This form is used by a public entity to exclude uncompensated elected or appointed officials from workers’ compensation insurance coverage for the upcoming policy year.

Rejection of Coverage By Partners and Sole Proprietors Performing Construction Work on Construction Sites

Form # WC45

Fillable  pdf MS Word

 

This form is used by partners and sole proprietors performing construction work on construction sites to reject workers' compensation insurance coverage.

Request for Certification

Form #WC109

Fillable  pdf MS Word

 

This form is used by employers to obtain certification status in the Colorado Workers’ Compensation Premium Cost Containment Program.

 

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