Form 61-A, Contractor’s Certification of Workers’ Compensation Liability, is the certificate a contractor completes when applying for or renewing a business license in a Virginia locality. The Virginia Workers' Compensation Commission (VWC) prepares it for local licensing authorities, and the copy published by the City of Chesapeake has Chesapeake entered as the locality. It records how the business insures workers' compensation liability, or why coverage is not required, and carries a signed certification. On FillingPDF you can fill out the form online and download or print the completed PDF; the Chesapeake Commissioner of the Revenue receives it only through the channels described below.
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What is 61-A?
Form 61-A, Contractor’s Certification of Workers’ Compensation Liability, is the certificate in which a contractor states how its business insures workers' compensation liability, or why coverage is not required, when it applies for or renews a business license with a Virginia locality.
The Virginia Workers' Compensation Commission (VWC) prepares and distributes the form to local licensing authorities for use under Section 58.1-3714 of the Code of Virginia. The form says it must be filed in each Virginia locality where a contractor applies for or renews a business license. The City of Chesapeake lists its copy of the PDF as Contractors Certification of Insuring Liability for Workers Comp.
The form has three working parts:
- A block for the official issuing the license: city, town or county, the name of the locality and the business license number.
- The contractor's business details and the method of insuring: an insurance carrier licensed in Virginia, self-insurance with a certificate of authorization from the VWC, a Group Self-Insurance Association (GSIA) licensed by the State Corporation Commission, a Professional Employer Organization (PEO) registered in Virginia, or another method explained on the form.
- A signed certification, made under penalty of law, that the signer is authorized to execute it, that the information is correct, and that the business complies with Chapter 8 of Title 65.2 of the Virginia Workers' Compensation Act and will stay in compliance while the license is in effect.
It is a certification, not an insurance policy: the form tells contractors not to attach any documents to it.
Who needs to file 61-A?
Contractors who apply for or renew a business license in a Virginia locality complete Form 61-A for that license. The form says it must be filed in each locality where the contractor applies or renews, so a contractor licensed in several localities files one in each.
- Contractors who carry workers' compensation coverage fill in the method of insuring, the insurer's name, the policy number and the policy dates.
- Contractors who check Check Here if Workers' Compensation is Not Required also give the reason (Less than 3 employees or Other, explained) and answer whether they hire independent contractors or subcontractors.
The form's note warns that corporate officers, LLC managers, part-time employees and employees of your subcontractors generally count as your employees for workers' compensation purposes. Filing a 1099, paying cash wages or calling a worker an "Independent Contractor" does not necessarily change employee status.
The signer must be duly authorized by the license applicant, so someone other than the applicant may sign if the applicant has authorized it. The top block is completed by the official issuing the license, not by the contractor. The City of Chesapeake's Business Tax Forms page states that its forms are for existing businesses; new businesses are directed to its Opening/Operating a Business - Tax and Licensing page.
When to file 61-A
File Form 61-A each time you apply for or renew a business license as a contractor in a Virginia locality. The form says it must be filed in every locality where you apply or renew, and the signer certifies that the business will remain in compliance with the Workers' Compensation Act during the effective period of the license.
No separate due date is printed on the form; it goes to the licensing authority with the license application or renewal. In Chesapeake, the Commissioner of the Revenue's Business Tax Forms page covers existing businesses, and the form must be completed, printed and signed before it is sent to that office. Anyone opening a new business is pointed to the city's Opening/Operating a Business - Tax and Licensing page for the required forms.
How to fill out 61-A
Check the locality block
The official issuing the license completes the top block: city, town or county, the name of the locality, and the business license number with any prefix or suffix. On this copy, City is checked and Chesapeake is entered.
Enter applicant and business names
Under Name of Applicant, enter Last and First name. In Business or Trade Name, give the complete business name; sole proprietors and partners include the trade name under which the business operates.
Enter mailing and business addresses
Enter the Applicant Mailing Address and the Business Address with city, state and ZIP. The business address must be the one used to receive mail from the U.S. Postal Service.
Enter your FEIN or tax ID
Enter the Federal Employer Identification Number (FEIN). If none has been issued, use the Temporary FEIN from the Virginia Tax Department; a sole proprietor with neither lists a Social Security number.
Select legal status and trade
Check Corp., L.L.C., Sole Prop, Partnership or Other, then enter the Type of Trade or Industry in which the business is classified.
Add contact details
Enter the Home Telephone and Business Telephone. Add the business E-mail Address if available.
Indicate the method of insuring
Indicate one method: Virginia-licensed carrier, self-insured, GSIA, PEO or Other (Explain). Enter the insurer's name, the policy, master policy or certificate number, and the policy effective date and period; never use an agency's name.
Complete the Not Required section
Only if workers' compensation is not required, check the box and state the reason: Less than 3 employees or Other (Explain). Then answer Yes or No to whether you hire independent contractors or subcontractors. Leave the For VWC Use Only box blank.
Sign, print your name and date
The applicant, or a person duly authorized by the applicant, signs the certification, prints the name and dates it.
Review and download the completed PDF
Check that every contractor field is filled and that no documents are being attached. Download or print the completed PDF from FillingPDF, sign it and send it as described under How to submit.
How to submit 61-A
The form is presented to the licensing authority. In Chesapeake that is the Commissioner of the Revenue's Office, which accepts a completed and signed business tax form by email attachment, fax or mail.
- Email: scan the signed form and send it as an attachment. Call the Business Tax Section at 757-382-6738 to confirm where to send it; alternate numbers are 757-382-6739 and 757-382-6740.
- Fax: Business Tax Section, 757-382-8822.
- Mail: Commissioner of the Revenue, Attn: Business Tax, P.O. Box 15285, Chesapeake, VA 23328.
- In person: the Commissioner of the Revenue Office is at 306 Cedar Road, Chesapeake, VA 23322 (phone 757-382-6455).
Complete, print and sign the form before sending it. Do not attach any documents to it. For questions about the form itself, the VWC can be reached toll-free at 1-877-664-2566 or at www.workcomp.virginia.gov. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Attaching a policy copy or any other document; the form states DO NOT ATTACH ANY DOCUMENTS TO THE CONTRACTOR’S CERTIFICATE.
- Entering the name of an insurance agency instead of the insurance company or other insuring entity; if the insurer is unknown, ask the agent.
- Leaving contractor fields blank; the instructions say all information requested is required, including the applicant's name, mailing address and phone number.
- Naming the state fund of West Virginia or Maryland as the insurer; neither is authorized to write workers' compensation insurance in Virginia.
- Checking Not Required because workers are paid by 1099, paid cash or called independent contractors; this does not necessarily change employee status.
- Not counting corporate officers, LLC managers, part-time employees or subcontractors' employees when deciding whether you have fewer than 3 employees.
- Omitting the policy effective date and policy period; the instructions ask for effective dates for all coverage.
- Skipping the Yes/No question about hiring independent contractors or subcontractors after checking that workers' compensation is not required.
- Sending the form to the Commissioner of the Revenue unsigned or unprinted; the city requires forms to be completed, printed and signed first.
Frequently asked questions
What is Form 61-A?
Form 61-A is the Contractor’s Certification of Workers’ Compensation Liability, prepared by the Virginia Workers' Compensation Commission for local licensing authorities. A contractor completes it to show how the business insures workers' compensation liability, or why coverage is not required, when applying for or renewing a business license.
Who has to file Form 61-A in Chesapeake?
Contractors applying for or renewing a business license in a Virginia locality, including Chesapeake. The form must be filed in each locality where the contractor applies or renews. The city's page treats these business tax forms as being for existing businesses; new businesses start on its Opening/Operating a Business page.
Do I attach my insurance policy to Form 61-A?
No. The instructions say not to attach any documents to the contractor's certificate. You enter the insurer's name, the policy or certificate number and the policy effective date and period on the form itself instead.
Can I email or fax Form 61-A to the Chesapeake Commissioner of the Revenue?
Yes. The city says a completed and signed business tax form can be scanned and sent as an email attachment, faxed to 757-382-8822 or mailed to P.O. Box 15285, Chesapeake, VA 23328. Call 757-382-6738 to confirm where to email it.
What do I check if I have fewer than 3 employees?
You may check the box that workers' compensation is not required and give the reason Less than 3 employees, then answer whether you hire subcontractors. The form notes that officers, LLC managers, part-time employees and your subcontractors' employees generally count as your employees.
Does a 1099 or an independent contractor label mean I don't need workers' comp?
Not necessarily. The form states that filing a 1099, paying cash wages or designating a worker an independent contractor does not necessarily alter employee status under the Workers' Compensation Act. For general coverage questions, call the Commission at 1-877-664-2566.
Can someone else sign Form 61-A for me?
Yes, if that person is duly authorized by the business license applicant. By signing, the person certifies under penalty of law that he or she is authorized, that the information is correct and that the business complies with Chapter 8 of Title 65.2 of the Virginia Workers' Compensation Act.
Can I fill out Form 61-A online on FillingPDF?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF does not file the form and is not connected to the City of Chesapeake or the VWC; you sign it and send it to the Commissioner of the Revenue yourself.
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