Form Wyo-790 - Out Of State Employer Questionnaire - Wyoming Department Of Workforce Services Page 2

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4. Provide information on all projects worked in Wyoming within the last 12 months.
(attach additional sheets if needed)
How long
Amount of
Monthly
Project
Project
was your
Project Name and Location
Start
End Date
company on
Payroll in
Date
the job?
Wyoming
5. Is your company currently submitting bids for future projects in Wyoming? Yes
No
Please provide all known information about the future project.
(attach additional sheets if needed)
How long
Amount of
Project
Project
Monthly
will your
Project Name and Location
End Date
Payroll in
Start
company be
Date
on the job?
Wyoming
6.
Who currently provides Workers’ Compensation Coverage for your company?
Carrier Name or State:
Policy or Account Number:
Does your Policy cover ALL employees who are working in Wyoming? Yes
No
If No, and you are in an industry required to have workers’ compensation coverage
under Wyoming law, you will be required to obtain Wyoming Workers’ Compensation
for all employees working in Wyoming who are not covered under your existing
policy
provided by your insurance company******
******You must provide proof of WC coverage

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