Homeowners of a 1, 2, 3 or 4 Family, Owner-occupied
Residence who are serving as their own general contractor on small jobs
that require a building permit may be eligible to fill out this form as
proof that they do not need a statutory workers' compensation policy
PO Box 188
6210 South Livonia Rd.
Phone: (585) 346-3130 ext.6
Fax: (585) 346-3650
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