ACORD 171FL Instructions

ACORD 171 FL (2004/04) – Florida Notice of Election of Coverage

Use this form to notify the Florida Department of Labor & EmploymentSecurity Bureau of W.C. Compliance, that sole proprietor(s) or partner(s) elect to be included in the definition of employee for the purpose of entitlement to benefits under a Workers Compensation policy.

This ACORD 171 FL is the same as the Florida Division of Workers’ Compensation form DWC 251 Revised February 2000.