Certificate of Workers' Compensation Insurance (Form 61A)

VWC Form: 

The Contractor’s Certificate of Workers’ Compensation Insurance (Form 61A) is a form issued by Commissioners of Revenue all over the Commonwealth in conjunction with Contractor’s business license filings.  Pursuant to § 58.1-3714, the governing body of each county, city or town must require every contractor to provide written certification at the time of any application for issuance or reissuance of a business license that such contractor is in compliance with workers’ compensation requirements and will remain in compliance during the effective period of the business license.  The form has been developed by the Workers’ Compensation Commission.  Contractors are asked to provide business, contact and workers’ compensation insurance information.  Contractors that do not list insurance coverage are asked to provide a reason.  The completed form assists the Commission in following up with uninsured contractors that may be required to insure under the Act.


The form is required to be completed fully and with care.  At the top of the form the locality issuing the form completes information as to what locality the form is issued from and the Contractor’s Business License Number.  The Contractor completes the rest of the form.  The Contractor should list their name, address, business and insurance information.  When listing workers’ compensation insurance it is important to list only active workers’ compensation insurance.  Listing of occupational Accident, Employer Liability or other insurance is not a substitute for workers’ compensation.  All insurance listed is verified and no other line of insurance will verify.  A Contractor that does not list workers’ compensation coverage is required to answer how many employees they have and whether they hire Independent Contractors or subcontractors with employees to assist in the work.  The form must be signed, dated and the Contractor’s name printed.  Incomplete forms will be returned to the Contractor for additional information.

Where to return the form:
The form is issued by Commissioners of Revenue and once completed the form is to be returned to the same licensing authority (the Commissioner of Revenue) where the Contractor obtained his or her business license.  These instructions are listed on the form in several places.  The forms are not returned to the Workers’ Compensation Commission.  The Commissioners of Revenue ensure that the Form 61A is completed with each business license application or renewal and then forward the forms in bulk on to the Workers’ Compensation Commission. 

Contractors that would like further information concerning Virginia workers’ compensation insurance requirements should review the Contractor’s Information sheet. Contractors with questions may contact the Insurance Department of the Commission by calling (804) 205-3586 or via e-mail at vwcinsurance@workcomp.virginia.gov.

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