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WORKERS COMP
CERTIFICATE
FORM
Require a fresh Workers Comp Certificate? Obtain one by completing the form below for a workers’ compensation certificate request.
I acknowledge that the information entered here is true and correct. I understand that once submitted, the cert can not be changed or modified unless I request a change. I understand that if I request a waiver of subrogation, there will be a $200 fee for each waiver of subrogation. I also agree to the OCMI Workers Comp & Professional Services, LLC. terms & conditions.