Notice Of Election To Bring Partners Or Self Employed Under NY WC {C-105.32}

<document>COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .State of New YorkTHIS AGENCY EMPLOYS AND SERVES PEOPLE WITH DISABILITIES WITHOUT DISCRIMINATION.:::::::Index No.WORKERS' COMPENSATION BOARDCalendar No.NOTICE OF ELECTION OF A PARTNERSHIP, LIMITED LIABILITY PARTNERSHIP, PROFESSIONAL LIMITED LIABILITY PARTNERSHIP, LIMITED LIABILITY COMPANY, PROFESSIONAL LIMITED LIABILITY COMPANY OR SOLE PROPRIETORSHIP TO BRING PARTNERS, MEMBERS OR SELF-EMPLOYED PERSONS UNDER THE COVERAGE OF THE NEW YORK STATE WORKERS' COMPENSATION LAWJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)THIS ELECTION IS EFFECTIVE AS OF THE DATE FILED WITH THE INSURANCE CARRIER To: (Print name and address of insurance carrier here)TAKE NOTICE that under the provisions of Sec. 54, subd. 8, of the New York Workers' Compensation Law as amended, the partnership as defined in Section 10 of the Partnership Law of New York State or the limited liability partnership (LLP) or professional limited liability partnership (PLLP) or limited liability company (LLC) or professional limited liability company (PLLC) or sole proprietorship named below elects to bring the partners, members or self-employed persons listed herein under the coverage of the New York Workers' Compensation Law with respect to all policies issued to the partnership, LLP, PLLP, LLC, PLLC or sole proprietorship by the insurance carrier named above.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Name of Partnership, LLP, PLLP, LLC, PLLC or Sole Proprietorship AddressPEOPLE OF THE STATE OF NEW YORK(County Where Principal Office is Located)GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the HonorableThis is a sole proprietorship having employees required to be covered under the NYS Workers' Compensation Law. This is a partnership as defined in Section 10 of the Partnership Law of New York State, having employees required to be covered under the NYS Workers' Compensation Law. This is not a limited partnership. This is a limited liability partnership or professional limited liability partnership having employees required to be covered under the NYS Workers' Compensation Law. This is a limited liability company or professional limited liability company having employees required to be covered under the NYS Workers' Compensation Law.,located at County ofo'clock in the day ofnoon, and at any recessed room, on the, 20, at adjourned date, to testify and give evidence as a witness in this action on the part of thePARTNERS, MEMBERS OR SELF-EMPLOYED PERSONS TO BE INCLUDED IN POLICYName and Address of partners, members, or self-insured persons included in policy. Copy of this notice should be sent to each person named below.Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a of your failure to comply., one of the Justices of thein Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)I am ageneral partnersole proprietorother (specify)memberAttorney(s) forof the herein named firm or company and certify that the above election to include partners, members or self-employed persons as set forth above, was duly made by the partnership, company, or sole proprietorship and was entered upon the records of the firm or company.Name of Firm or CompanyDate Office and P.O. Address(Signature)Telephone No.Type Name and TitleTelephone No.: Facsimile No.: E-Mail Address:PLEASE NOTE This form applies only to the partners, members or self-employed persons here certified and should be sent at once to the insurance carrier. A new Form C-105.32 must be filed whenever new or additional partners, members or self-employed persons are to be included or when the insurance carrier is changed. For copy of Sec. 54, subd. 8, of the Workers' Compensation law and Sec.10 of the Partnership Law see reverse side.Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comwww.wcb.state.ny.usC-105.32 (4-04)COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.SECTION 54, SUBDIVISION 8 OF THE NEW YORK WORKERS' COMPENSATION LAWCalendar No.Section 54, Subd. 8JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)"A self-employed person or a partner of a partnership as defined in section ten of the partnership law but not including a limited partner, having other persons who are employees required to be covered under this chapter may be included in the compensation insurance contract or covered under a certificate of self-insurance. Such election shall be made by any such partnership or sole proprietorship filing with the insurance carrier or the chairman in the case of self-insurance upon a form prescribed by the chairman of the workers' compensation board, a notice that the partnership or sole proprietorship elects to include the partner or partners or the self-employed person named in the notice in the coverage of this chapter. Such election shall be effective with respect to all policies issued to such partnership or sole proprietorship by such insuance carrier as long as it shall continuously insure the employees of the partnership or sole proprietorship. Such election shall be final and binding upon the partner or self-employed person named in the notice untill revoked by the partnership or sole proprietorship. A self-employed person or a partner of a partnership having no other persons who are employees required to be covered under this chapter shall be deemed to be excluded from coverage under this chapter unless he elects to be covered. Such coverage may be effected by obtaining an insurance policy.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOGREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the HonorableThe self-employed persons or partners of a partnership brought within the coverage of the insurance contract, and the dependents of any such self-employed persons or partners of a partnership shall have the same rights and remedies as any employee or his dependents and shall be entitled to c