Mower County, MN · Mower County
Certificate of Compliance Minnesota Workers’ Compensation Law
Business license applicants complete this certificate to provide workers’ compensation coverage information or explain why coverage is not required.
At a glance
- Issued by
- City of Mower County · Mower County, Mower County, Minnesota
- Notarization
- Not required: file this form without a notary.
- Official source
- co.mower.mn.us
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Mower County business license applicants use this form to provide evidence of workers’ compensation compliance or explain why they are not required to carry coverage. It asks for business and contact details, then information about an insurance policy or self-insurance, or the reason coverage is not required. Self-insured applicants must attach authorization, and the applicant must certify, sign, and date the form.
Who needs it
A business license applicant completes this form to provide workers’ compensation information or explain why the business is not required to carry coverage.
How to submit it
Submit it to the county office named on the form; check the county website for current contact details.
About notarization
This form is signed without a notary; the applicant certifies the information and signs and dates the form.
How to submit this form
- 1
Download the Form
Download the Workers’ Compensation Compliance Certificate.
- 2
Complete Business Details
Enter the business and contact information requested on the form.
- 3
Provide Coverage Information
Complete the section that applies to your business. Self-insured applicants must attach authorization to self-insure.
- 4
Sign and Date
Certify the information, then provide the applicant’s printed name, signature, title, and date.
- 5
Submit to the County
Submit the completed form to the county office named on it; check the county website for current contact details.
Frequently asked questions
- What is the Workers’ Compensation Compliance Certificate?
- It is a form for business license applicants to provide workers’ compensation insurance or self-insurance information, or explain why coverage is not required.
- What information does the form ask for?
- It asks for business and contact details, insurance policy information or a reason coverage is not required, and the applicant’s printed name, signature, title, and date.
- Do I need a notary for the Workers’ Compensation Compliance Certificate?
- No. The applicant certifies the information and signs and dates the form; it does not require notarization.
- How do I submit the Workers’ Compensation Compliance Certificate?
- Submit it to the county office named on the form. The document does not provide a submission address or other contact details, so check the county website for current information.