Contractor's Certification of Workers ... - Virginia
Return your completed form to the Workers’ Compensation Commission at 1000 DMV Drive, Richmond, VA 23220 Attn: Insurance Department. Note: The state funds of West Virginia and Maryland are not authorized to write workers’ compensation insurance in Virginia. DO NOT ATTACH ANY DOCUMENTS TO THE CONTRACTOR’S CERTIFICATE. 61A rev 10/02/2017 ................
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