Village of Croton-on-Hudson, NY - Insurance Forms

Welcome to the website for the Village of Croton on Hudson, New York

Village Seal

Village of Croton-on-Hudson

1 Van Wyck Street
Croton-on-Hudson, NY 10520

Phone: 914-271-4781
Fax: 914-271-2836

Hours: Mon. - Fri., 8:30 am - 4 pm

Insurance Forms

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Description

Insurance Forms:

Document	Description
Insurance Requirements	All applicants requesting a permit must show proof of insurance coverage. This document explains the required coverage and documentation that must be submitted with every permit application.
BP-1 Affidavit of Exemption to Show Specific Proof of Workers' Compensation Insurance Coverage for a 1, 2, 3, or 4-family owner-occupied residence	This form may be used (under certain conditions, see form) by homeowners of 1, 2, 3 or 4-family owner-occupied residences (including condominiums) listed on the permit application, to document they are not required to show specific proof of worker's compensaiton insurance coverage. This form must be notarized.
WC/WD-100: Affidavit for New York Entities and Any Out of State Entities with No Employees, that New York State Workers' Compensation and/or Disability Benefits Insurance Coverage is Not Required	This form is used to document those New York entities and any out of state entities with no employees, that New York State workers' compensation and/or disability benefits insurance coverage is not required. This form must be notarized and stamped as received by the NYS Workers' Compensation Board for it it be accepted
WC/WD-101: Affidavit That an Out-of-State or Foreign Employer Working in New York State Does Not Require a Specific New York State Workers' Compensation and/or Disability Benefits Insurance Coverage	This form is used to document an OUT-OF-STATE OR FOREIGN EMPLOYER working in New York State does not require specific New York State Workers' Compensation and/or disability benefits insurance coverage. This form must be notarized and stamped as received by the NYS Workers' Compensation Board for it to be accepted.