Employer Notice Of Workers Compensation Insurance Coverage {16 NJ A}

Form 16 NJ A POSTING NOTICE The law requires every insured employer to post and maintain notices naming the company insuring its compensation liability in a conspicuous place or places in and about the employers place of business. The form of notice is prescribed by the Commissioner of Insurance and shall be clearly printed on a minimum of 90# index, 8" by 11" in size. The content and arrangement of items must be consistent with the layout shown below. In accordance with 3:2-1 a duplicate filing must be made before the form is placed in use. NOTICE The undersigned employer hereby gives notice that the pay- ment of compensation to employees and their dependents has been secured in accordance with the provisions of the Employ- ers Liability Insurance Law, Title 34, Chapter 15, Article 5, Revised Statutes New Jersey, by insuring with the ( ) Insurance Company for the period Beginning ................ Ending ................... Employer ........................................... In accordance with the above cited law, notice of compliance must be posted and maintained conspicuously in and about the employers workplaces. Form 16 NJ A American LegalNet, Inc. www.USCourtForms.com