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Description of c105 2 form
STATE OF NEW YORK WORKERS’ COMPENSATION BOARD CERTIFICATE OF NYS WORKERS’ COMPENSATION INSURANCE COVERAGE 1a. Legal Name & Address of Insured (Use street address only) 1b. Business Telephone Number of Insured 1c. NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State,...
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