Compliance with Workers' Compensation Act - Cecil County Health Department

Statement of Compliance with the Workers' Compensation Act

"*" indicates required fields

Section 1-202 of the Health-General Article of the Annotated Code of Maryland requires that prior to issuance of any license or permit by this office, the applicant must provide either a worker's compensation insurance policy or binder number, or a Certificate of Compliance from the State of Maryland Workers' Compensation Commission.
A Certificate of Compliance is required for a business owner with no employees. Certain other legal entities with no employees other than corporate officers or members may also apply for a Certificate of Compliance.
Contact the Workers' Compensation Commission at 410-864-5297 or by e-mail at [email protected] for information on how to obtain a Certificate of Compliance.

Insurance Company:*

Policy or Binder Number:*

Upload*

Please upload a clear scan, photo, or digital copy of the Certificate

Accepted file types: doc, pdf, jpg, png, Max. file size: 50 MB.

Digital Signature*

06/05/2023

Title*

Type of License*

Company Name*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Does the location of the business differ from the above mailing address?*

Yes

Location of Business*

Street Address Address Line 2 City State ZIP Code

Comments

This field is for validation purposes and should be left unchanged.

Compliance with Workers’ Compensation Act

Statement of Compliance with the Workers' Compensation Act