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Form DWC83 Agreement for Certain Building and Construction Workers - Texas
What Is DWC Form 83?
DWC Form 83, Agreement for Certain Building and Construction Workers , is a Texas State form used for residential and small commercial construction contractors to establish the obligations between a hiring contractor and the independent contractor being hired in regards to workers' compensation insurance. This document is only applicable to the following construction contractor work: residential structures (including single-family, duplex, triplex, and four-plex dwellings), commercial structures including more than four-family properties, but not in excess of three stories or 20,000 sq. ft., and any appurtenance related to these buildings.
This document must be executed before the hiring contractor's related work is to start. This agreement will be in place for one year from the filing date and is applicable to all work between the hiring contractor and independent contractor. A new filing must be submitted at the end of each year. The DWC and the insurance agent must be given notice, using Form DWC-84, if any subsequent work between these parties is to follow any different agreement.
This Texas DWC Form 83 is issued by the Texas Department of Insurance, Division of Workers' Compensation and the latest form was issued on April 1, 2018 . A printable DWC Form 83 version is available for download below.
How to Fill Out DWC Form 83?
Follow these DWC Form 83 instructions below. Four entities will retain this completed form for their records, with original to be filed with the state of Texas. More details below.
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Check only one of the two boxes at the top of the page:
- The box to the left affirms the agreement of an independent relationship, in which the independent contractor and it's employers are not entitled to worker's compensation coverage by the hiring contractor, and hiring contractor insurance carrier shall not require insurance premiums be paid by the hiring contractor for the independent contractor.
- The box to the right establishes the agreement that the hiring contractor will purchase workers' compensation insurance for the independent contractor and its employees. Below this box, also check the applicable box whether the hiring contractor will withhold or not the insurance coverage cost from the independent contractor's contract price. Also complete on applicable spaces the term (dates) of agreement, location of each affected job site (or state this is a blanket agreement), and the estimated number of employees affected.
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Enter in the applicable spaces the hiring contractor's federal tax ID number and address. Print and sign the hiring contractor's name and enter the date.
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Enter in the applicable spaces the independent contractor's federal tax ID number, address. Print and sign the hiring contractor's name and enter the date.
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Hiring a contractor to file this completed form, within 10 days of the date of execution, and send it to both the Texas Department of Insurance, Division of Workers' Compensation (the original), and the hiring contractor's workers' compensation insurance carrier. These filings are to be sent by personal delivery or registered certified mail. Both the hiring contractor and independent contractor must also retain a copy.
