To assist Check Cashers in properly documenting ther customer files in connection with Worker's Compensation documentation, pursuant to 69V-560.704, and ensuring that accurate information is being entered on the Electronic Log as required by 560.310, the following form, Affidavit of Employees and Coverage should be completed for each commercial check cashing client. A commercial client is one that cashes checks payable to a company.

This affidavit requires that your client specifies the number of full and part time employees, as well as the industry on which said client operates.

Once the form is completed, locate the NCCI code from the list below and write it on the form. This will give you an idea of the premium coverage required for that type of industry.

Please note that you must still search, print, and include on your customer documentation the proof of coverate (see our Tools section). You must also enter the policy number or the Certificate of Excemption number on your electronic log, unless the client is excempt from having W.C. coverage.


Affidavit of Employees and Coverage
Class Codes 2013 Rates 2014 Rates
(Code - Description - 2013 rate - 2014 rate)

0005 - Farm: Nursery Employees $5.71 $5.85
0008 - Gardening - Market or Truck $3.96 $4.22
0016 - Farm: Orchard & Drivers - By Contractor $10.89 $11.24
0034 - Farm: Poultry or Egg Producer $5.88 $5.94
0035 - Farm: Florist $3.45 $3.50
0036 - Farm: Dairy $6.17 $5.14
0037 - Farm: Field Crops $6.12 $6.17
0042 - Landscape Gardening $7.88 $8.23
0050 - Farm Machinery Operation – By Contractor $9.99 $9.49
0052 - Orchard & Grove Owners & Operations $5.88 $5.97
0083 - Farm: Cattle Or Livestock $7.36 $7.36
0106 - Tree Trimming $17.67 $19.09
0113 - Farm: Fish Hatchery $5.68 $6.33
0153 - Lawn Or Shrub Spraying $7.47 $7.33
0173 - Farm: Berry $1.13 $1.05
0251 - Irrigation Works Operation $5.58 $5.65
0917 - Residential Cleaning Services $5.91 $6.77
1322 - Oil or Gas Well: Cleaning or Swabbing of Old Wells $12.69 $12.83
2003 - Bakeries $5.19 $5.15
2016 - Breakfast Food Manufacturing $3.14 $3.02
2039 - Ice Cream Manufacturing $2.89 $2.54
2041 - Confection Manufacturing $5.58 $5.30
2065 - Milk Products Manufacturing NOC $5.08 $4.75
2105 - Fruit Packing $4.92 $5.44
2110 - Pickle Manufacturing $5.14 $4.17
2300 - Plush Manufacturing $3.25 $3.42
2305 - Textile Fiber Manufacturing $2.15 $2.05
2386 - Lace Manufacturing $3.40 $3.16
2388 - Embroidery Manufacturing $2.60 $2.64
2501 - Clothing Manufacturing $3.49 $3.17
2503 - Custom Dressmaking $1.80 $1.86
2534 - Artificial Feather Or Flower Manufacturing $3.85 $3.33
2585 - Laundry NOC $5.34 $5.03
2587 - Towel Supply Co. & Route Supervisors $5.95 $5.58
2589 - Laundry & Dry Cleaning Store $3.02 $2.98
2670 - Glove Manufacturing - Leather Or Textile $2.93 $2.67
2688 - Leather Goods Manufacturing NOC $4.03 $4.13
2790 - Pattern Making NOC $2.15 $2.22
2797 - Manufactured, Modular, or Prefab Home Manufacturing – Shop Work $6.83 $7.23
2802 - Carpentry – Shop Only $7.99 $7.91
2835 - Brush Or Broom Assembly $3.95 $3.71
2836 - Brush Or Broom Manufacturing NOC $3.89 $3.64
2881 - Furniture Assembly $4.21 $3.80
2883 - Wood Furniture Manufacturing NOC $6.66 $6.58
3030 - Iron or Steel Works – Structural $11.28 $10.21
3040 - Iron or Steel Works – Ornamental $11.17 $9.87
3064 - Metal Sign Manufacturing $10.18 $8.39
3069 - Sheet Metal Products Manufacturing $7.01 $6.79
3076 - Sheet Metal Products Manufacturing – Shop Only $5.25 $4.96
3113 - Tool Manufacturing - Not Drop Or Machine Forged NOC $3.56 $3.45
3119 - Needle Manufacturing $2.04 $1.70
3131 - Metal Button Manufacturing $2.50 $2.34
3145 - Screw Manufacturing $3.23 $3.08
3146 - Hardware Manufacturing NOC $4.93 $4.75
3179 - Electrical Apparatus Manufacturing NOC $3.04 $3.10
3188 - Plumbers' Supplies Manufacturing NOC $4.03 $3.31
3220 - Can Manufacturing $2.57 $2.28
3223 - Lamp Or Lantern Manufacturing NOC $4.92 $4.18
3257 - Wire Goods Manufacturing NOC $4.60 $4.24
3270 - Eyelet Manufacturing $3.73 $3.69
3365 - Welding or Cutting NOC $16.36 $14.32
3383 - Jewelry Manufacturing $1.68 $1.66
3385 - Watch Manufacturing $1.13 $1.03
3507 - Construction or Agricultural Machinery Manufacturing $5.61 $5.27
3548 - Printing Machine Manufacturing $2.64 $2.83
3574 - Adding Machine Manufacturing NOC $2.34 $2.25
3629 - Precision Machined Parts Manufacturing NOC $2.24 $2.13
3632 - Machine Shop NOC $4.84 $4.57
3634 - Valve Manufacturing $2.54 $2.10
3635 - Gear Manufacturing Or Grinding $4.53 $4.46
3638 - Ball Bearing Manufacturing $2.66 $2.55
3643 - Electric Power or Transmission Equipment Manufacturing $2.78 $2.55
3648 - Automotive Lighting, Ignition Or Starting $2.96 $2.48
3681 - Telephone Or Telegraph Apparatus Manufacturing $1.17 $1.08
3685 - Instrument Manufacturing NOC $1.38 $1.23
3719 - Oil Still Erection or Repair $3.65 $3.33
3724 - Machinery Or Equipment Erection/Repair NOC $6.05 $5.53
3726 - Boiler Installation or Repair – Steam $9.07 $8.12
3808 - Automobile Manufactuing or Assembly $4.38 $3.69
3821 - Automobile Recycling $9.83 $9.85
3822 - Automobile, Bus, Truck or Trailer Body Manufactuing Die – Pressed Steel $9.32 $8.52
3824 - Automobile, Bus, Truck or Trailer Body Manufacturing NOC $7.24 $7.53
3865 - Bicycle Manufacturing Or Assembly $4.65 $3.79
4034 - Concrete Products Manufacturing $9.37 $10.36
4036 - Plaster Board or Plaster Block Manufacturing $4.75 $4.30
4109 - Integrated Circuit Manufacturing $1.23 $1.11
4111 - Glassware Manufacturing - No Automatic Blowing Machine $3.56 $3.45
4113 - Glass Manufacturing $3.40 $3.23
4130 - Glass Merchant $6.80 $6.36
4149 - Optical Goods Manufacturing NOC $1.23 $1.01
4251 - Stationery Manufacturing $4.21 $3.55
4279 - Paper Goods Manufacturing $6.00 $5.12
4282 - Dress Pattern Manufacturing $3.19 $3.07
4299 - Printing $2.89 $2.98
4351 - Photoengraving $1.43 $1.43
4352 - Engraving $2.53 $2.36
4361 - Photographer - All Employees $1.44 $1.61
4431 - Phonograph Record Manufacturing $1.98 $1.76
4432 - Fountain Pen Manufacturing $2.48 $2.49
4452 - Plastics Manufacturing: Fabricated Products NOC $5.61 $4.58
4484 - Plastics Manufacturing: Molded Products NOC $5.26 $4.93
4557 - Ink Manufacturing $3.37 $3.46
4558 - Paint, Lacquer or Varnish Manufacturing $3.88 $3.99
4611 - Drug, Medicine Or Pharmaceutical Manufacturing NOC $2.47 $2.28
4683 - Oil Manufacturing - Vegetable - NOC $4.75 $4.22
4692 - Dental Laboratory $0.95 $0.96
4693 - Pharmaceutical Goods Manufacturing NOC $1.61 $1.64
4710 - Candle Manufacturing $6.65 $5.91
4717 - Butter Substitutes Manufacturing $2.96 $2.75
4720 - Soap Or Synthetic Detergent Manufacturing $4.51 $3.77
4923 - Photographic Supplies Manufacturing $4.83 $4.96
5020 - Ceiling Installation – Suspended Acoustical Grid Type $9.52 $10.30
5022 - Masonry NOC $10.92 $11.77
5037 - Painting: Metal Structures Over 2 Stories $39.44 $46.14
5040 - Iron or Steel: Erection – Frame Structures $23.04 $21.86
5057 - Iron or Steel: Erection NOC $12.59 $12.14
5059 - Iron or Steel: Erection – Frame Structures Not Over 2 Stories $53.12 $46.42
5069 - Iron or Steel: Erection – Dwellings Not Over 2 Stories $39.36 $35.15
5102 - Door, Door Frame or Sash Erection – Metal $9.91 $9.37
5146 - Furniture Or Fixtures Installation $7.00 $8.19
5160 - Elevator Erection or Repair $3.54 $3.58
5183 - Plumbing NOC $5.63 $5.67
5188 - Automatic Sprinkler Installation $6.41 $6.77
5190 - Electrical Wiring - Within Buildings $6.17 $6.09
5191 - Office Machine Installation Or Repair $1.27 $1.20
5192 - Vending Machines – Installation, Service or Repair & Salespersons $4.17 $4.10
5213 - Concrete Construction NOC $12.51 $12.77
5215 - Concrete Work – Construction of Private Residence $16.46 $14.66
5221 - Concrete or Cement Work – Floors, Driveways & Sidewalks $6.20 $6.38
5222 - Concrete Construction for Bridges or Culverts $9.88 $10.60
5223 - Swimming Pool Construction – Not Iron or Steel $5.86 $6.15
5348 - Stone, Mosaic or Terrazzo or Ceramic Tile Work – Inside $5.63 $5.78
5402 - Hothouse Erection – All Operations $5.42 $6.33
5403 - Carpentry NOC $11.92 $11.96
5437 - Carpentry - Interior Trim & Cabinet Work $8.62 $8.23
5443 - Lathing $5.53 $5.75
5445 - Wallboard Installation Within Buildings $7.87 $8.00
5462 - Glazier – Away From Shop $10.56 $10.08
5472 - Asbestos Contractor – Pipe and Boiler Work Exclusively $21.02 $21.85
5473 - Asbestos Contractor NOC $13.35 $15.60
5474 - Painting or Paperhanging NOC $10.23 $11.04
5478 - Floor Installation: Carpet, Linoleum, Vinyl or Rubber Tile $6.28 $5.51
5479 - Insulation Work NOC $10.45 $11.07
5480 - Plastering NOC $9.68 $8.91
5491 - Paperhanging $6.46 $5.67
5506 - Street or Road Construction: Paving or Repaving $9.36 $9.33
5507 - Street or Road Construction: Subsurface Work $7.96 $7.20
5508 - Street or Road Construction: Rock Excavation $19.09 $18.32
5509 - Street or Road Maintenance: County or State Department $10.44 $11.67
5535 - Sheet Metal Work – Installation $9.47 $10.44
5537 - Heating, Ventilation, A/C & Refrigeration $7.69 $7.86
5551 - Roofing $18.17 $18.62
5606 - Contractor - Construction Supervisor $1.95 $1.99
5610 - Debris Removal $7.16 $7.92
5613 - Debris Removal – Temporary Labor Service $18.22 $18.56
5645 - Carpentry – Detached One or Two Family Dwellings $15.84 $16.31
5651 - Carpentry – Dwellings of 3 Stories or Less $11.32 $9.94
5703 - Building Raising or Moving $23.56 $21.39
5705 - Salvage Operation – No Wrecking $11.91 $13.85
6017 - Dam or Lock Construction: Concrete Work $12.44 $10.91
6018 - Dam or Lock Construction: Earth Moving or Placing $4.31 $5.00
6045 - Levee Construction $3.87 $4.42
6204 - Drilling NOC $16.06 $15.63
6206 - Oil or Gas Well: Cementing $5.12 $5.27
6213 - Oil or Gas Well: Specialty Tool Operation NOC – By Contractor $3.74 $4.04
6214 - Oil or Gas Well: Perforating of Casing – All Employees $4.65 $4.63
6216 - Oil or Gas Lease Work NOC – By Contractor $8.72 $8.61
6217 - Excavation $7.30 $7.80
6229 - Irrigation or Draining System Construction $7.48 $7.25
6233 - Oil or Gas Pipeline Construction $4.73 $5.18
6235 - Oil or Gas Well: Drilling or Redrilling $9.87 $9.53
6236 - Oil or Gas Well: Installation or Recovery of Casing $15.56 $15.20
6237 - Oil or Gas Well: Instrument Logging or Survey Work $2.13 $2.20
6251 - Tunneling – Not Pneumatic $10.18 $9.31
6252 - Shaft Sinking $8.52 $7.46
6260 - Tunneling – Pneumatic $6.23 $6.05
6306 - Sewer Construction $7.18 $7.16
6319 - Gas Main or Connection Construction $5.44 $6.07
6325 - Conduit Construction – Cable or Wires $8.16 $8.94
6400 - Metal Fence Construction $11.52 $11.01
6504 - Confection And Food Sundries Manufacturing $5.41 $4.58
6836 - Marina $6.19 $5.87
7380 - Drivers $6.51 $6.42
7383 - College Or School: School Bus Drivers $5.17 $5.68
7538 - Electric Light or Power Line Construction $14.42 $15.07
7600 - Telecoms – Telephone, Cable TV, or Satellite $3.97 $4.56
7605 - Burglar Alarm Installation or Repair $3.56 $3.68
7610 - Radio Broadcasting Station $0.77 $0.70
7855 - Railroad Construction $9.07 $8.78
8001 - Store: Florist $4.64 $5.18
8002 - Automobile Rental Company $3.58 $3.73
8006 - Gas Station: Self-Service/Convenience/Grocery $3.52 $3.73
8008 - Store: Clothing, Wearing Apparel Or Dry $2.14 $2.14
8010 - Store: Hardware $2.39 $2.45
8013 - Store: Jewelry $0.72 $0.73
8015 - Copying Or Duplicating Service - All Employees $1.15 $1.29
8017 - Store: Retail NOC $2.07 $2.11
8018 - Store: Wholesale NOC $4.12 $3.97
8021 - Store: Meat, Fish Or Poultry $4.53 $5.18
8031 - Store: Meat, Fish Or Poultry - Retail $3.80 $3.76
8032 - Store: Clothing, Apparel, and Dry Goods $3.30 $3.47
8033 - Store: Meat/Grocery/Provision Combination $2.72 $2.75
8039 - Store: Departmental - Retail $3.49 $3.18
8044 - Store: Furniture $3.83 $4.00
8045 - Store: Drug-Retail $0.62 $0.57
8046 - Store: Automobile Parts And Accessories $3.35 $3.57
8047 - Store: Drug-Wholesale $1.33 $1.27
8058 - Building Material Dealer $5.60 $5.08
8061 - Store: Groceries & Provisions - Convenience $3.99 $4.20
8072 - Store: Book, Record, Compact Disc - Retail $1.07 $1.17
8102 - Seed Merchant $2.70 $2.68
8107 - Machinery Dealer NOC $4.74 $5.05
8111 - Plumbing Supplies Dealer $3.22 $3.10
8203 - Ice Dealer $7.34 $8.06
8209 - Vegetable Packing $6.00 $6.46
8215 - Feed, Fertilizer, Hay, or Grain Dealer $8.13 $7.19
8227 - Construction or Erection – Permanent Yard $7.87 $8.47
8232 - Lumberyard – New Materials Only $5.37 $5.29
8235 - Sash, Door or Assembled Millwork Dealer $6.25 $6.34
8264 - Bottle Dealer – Used $6.52 $7.13
8265 - Iron or Steel Scrap Dealer $11.82 $9.54
8291 - Storage Warehouse – Cold $7.45 $6.34
8292 - Storage Warehouse NOC $6.66 $6.03
8380 - Auto Service/Repair Center $3.54 $3.66
8381 - Gasoline Station - Retail - Self-Service $2.53 $2.31
8393 - Automobile Bumper Repair $3.18 $2.70
8601 - Architect Or Engineer - Sales $0.92 $0.81
8602 - Surveyors $0.92 $1.05
8603 - Architectural Or Engineering Firm - Clerical $0.27 $0.23
8721 - Real Estate Appraisal Company - Outside $0.33 $0.37
8723 - Insurance Co. - Including Clerical & Sales $0.27 $0.26
8742 - Salespersons - Outside $0.53 $0.52
8745 - News Agent - Not Retail Dealer $6.10 $5.51
8748 - Automobile Salespersons $0.79 $0.81
8800 - Mailing Company & Clerical $1.76 $1.56
8803 - Auditors, Accountant Or Factory Cost $0.17 $0.15
8810 - Clerical Office Employees. NOC $0.27 $0.26
8820 - Attorney Offices $0.21 $0.21
8831 - Hospital - Veterinary $2.23 $2.27
8832 - Physician & Clerical $0.45 $0.46
8855 - Banks & Trust Co. - All Employees $0.27 $0.26
8868 - College - Professional Employees & Clerical $0.58 $0.60
8869 - Child Care Center - All Employees $1.44 $1.59
9012 - Apartment Property Managers And Leasing $1.71 $1.71
9014 - Buildings - Operated By Contractors $5.26 $5.21
9015 - Buildings - Operated By Owner Or Lessee $5.02 $5.14
9016 - Amusement Park Or Exhibition Operation $3.48 $3.08
9052 - Hotel: All Other Employees & Salesperson $3.80 $3.83
9058 - Hotel: Restaurant Employees $2.49 $2.54
9060 - Club - Country & Clerical $2.39 $2.43
9061 - Club NOC & Clerical $2.51 $2.45
9082 - Restaurant NOC $2.59 $2.55
9083 - Fast Food Restaurant $2.76 $2.74
9084 - Wine Bar / Comedy Club / Restaurants $2.74 $2.75
9093 - Bowling Lane $2.56 $2.41
9101 - College - All Other Employees $5.02 $4.99
9102 - Lawn Maintenance $4.62 $4.66
9154 - Theater NOC $2.45 $2.45
9220 - Cemetery Operations $8.26 $8.57
9402 - Street Cleaning $8.68 $9.45
9501 - Painting: Shop Only $4.59 $4.58
9516 - Radio, TV, Video & Audio Equip Install/Service $3.93 $3.99
9519 - Electrical Appliances – Install, Service or Repair $4.07 $4.67
9521 - House Furnishings Installation NOC & Upholstering $6.18 $6.30
9522 - Upholstering $2.95 $2.89
9534 - Mobile Crane and Hoisting Service Contractors $8.97 $8.68
9554 - Sign Installation, Maintenance, Repair, Removal, or Replacement $11.68 $12.34
9586 - Barber Shop $1.15 $1.25
9620 - Funeral Director $1.73 $1.49

- See more at: http://www.floridawc.com/workerscompensation/policy/rates/#sthash.sidu4jOn.dpuf
Information and forms for Exemption from Coverage