Ohio_BWC_Certificate.pdf
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- Attached to
- Agency Administered OH|429-26-3350
- Contract number
- 429-26-3350
- Issued by
- Ohio
About this file
This document is a Certificate of Ohio Workers' Compensation issued by the Ohio Bureau of Workers' Compensation (BWC) for Agiliti Health Inc, a company located in Eden Prairie, Minnesota. The certificate covers the policy period from July 1, 2025, to July 1, 2026, with policy number 00883486. The policy is administered through Sedgwick Managed Care Ohio and includes corporate officers Thomas Leonard and James Pekarek.
The workers' compensation policy covers multiple employee class codes, including instrument manufacturing, office machine installation and repair, drivers and messengers, aviation personnel transportation, wholesale store operations, outside sales, and clerical office employees. The document specifies that there are no elective individuals covered under this policy. The certificate affirms that Agiliti Health Inc participates in the Ohio State Insurance Fund and is entitled to associated rights and benefits, provided that premiums and assessments are paid by the applicable due date.
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Other files
| File | Type | Posted |
|---|---|---|
| DOC101425-10142025144545.pdf | ||
| Agiliti_FFR.pdf | ||
| Agiliti_Health_Auto-WC-Umbrella_Certificate.pdf |
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Text version
Mike DeWine, Governor Jim Tressel, Lt. Governor Stephanie McCloud, Administrator/CEO
1-800-644-6292 BWC.Ohio.govBureau of Workers' Compensation
30 West Spring Street Columbus, Ohio 43215-2256
#BWNFVSQ04/18/2025
Date Mailed .Invisible_TemplateName=DP29Delivery_Channel=emailInvisible_Document_Date=2025-04-18Invisible_ClaimNumber=undefinedInvisible_PolicyNumber =00883486Invisible_Recipient=Agiliti Health IncInvisible_AddressLine1=11095 VIKING DR STE 300Invisible_AddressLine2=undefinedInvisible_City=EDEN PRAIRIEInvisible_State =MNInvisible_zip =55344-7219Invisible_Country=United StatesInvisible_Document_Context =PolicyInvisible_Watermark_Name =\\mswg9\CoreSystem\PP\ALC\Images\blank.tifInvisible_Creator_Name =BATCH Invisible_Participation_Type =InsuredInvisible_QuoteNumber =undefinedInvisible_FEIN =undefined
Benefits Agiliti Health Inc
11095 VIKING DR STE 300
EDEN PRAIRIE MN 55344-7219
IMPORTANT DOCUMENT: REMOVE AND POST
DP-29 BWC-1629 (Rev. Jan. 10, 2019)
30 W. Spring St.
Columbus, OH 43215
Certificate of Ohio Workers' Compensation This certifies that the employer listed below participates in the Ohio State Insurance Fund as required by law.
Therefore, the employer is entitled to the rights and benefits of the fund for the period specified. This certificate is only valid if premiums and assessments, including installments, are paid by the applicable due date. To verify coverage, visit www.bwc.ohio.gov, or call 1-800-644-6292.
This certificate must be conspicuously posted.
Policy number and employer 00883486
Period Specified Below 07/01/2025 to 07/01/2026
Agiliti Health Inc
11095 VIKING DR STE 300
EDEN PRAIRIE MN 55344-7219
www.bwc.ohio.gov Issued by: BWC
Administrator/CEO You can reproduce this certificate as needed.
Ohio Bureau of Workers' Compensation
Required Posting
Section 4123.54 of the Ohio Revised Code requires notice of rebuttable presumption. Rebuttable presumption means an employee may dispute or prove untrue the presumption (or belief) that alcohol, marihuana or a controlled substance not prescribed by the employee's physician is the proximate cause (main reason) of the work-related injury.
The burden of proof is on the employee to prove the presence of alcohol, marihuana or a controlled substance was not the proximate cause of the work-related injury. An employee who tests positive or refuses to submit to chemical testing may be disqualified for compensation and benefits under the Workers' Compensation Act.
You must post this language with the Certificate of Ohio Workers' Compensation.
Policy Information
Policy Information for the policy period beginning from 12:01 AM on 07/01/2025 to 12:01 AM on 07/01/2026.
Policy Number and Employer MCO
00883486 Agiliti Health Inc
11095 VIKING DR STE 300
EDEN PRAIRIE MN 55344-7219
Sedgwick Managed Care Ohio
P.O. BOX 1040
DUBLIN OH 43017
Additional Insured’s Name and Address Effective Date Expiration Date
Individuals Eligible for Elective Coverage Individuals Eligible for Elective Coverage Covered (Yes/No) Elective Coverage Type
No Elective Individuals.
**Please refer to our website for reporting guidelines/requirements.
Corporate Officer Effective Date Expiration Date Thomas Leonard 07/01/2025 07/01/2026 James Pekarek 07/01/2025 07/01/2026
**Please refer to our website for reporting guidelines/requirements.
Employee Class Codes and Descriptions Class Code Class Code Description
3685 INSTRUMENT MFG. NOC.
5191 OFFICE MACHINE INSTALLATION, INSPECTION, ADJUSTMENT OR REPAIR.
7380 DRIVERS, CHAUFFEURS, MESSENGERS, AND THEIR HELPERS NOC-COMMERCIAL
7421 AVIATION-TRANSPORTATION OF PERSONNEL IN CONDUCT OF EMPLOYER'S BUS
8018 STORE-WHOLESALE-NOC
8742 SALESPERSONS OR COLLECTORS-OUTSIDE
8810 CLERICAL OFFICE EMPLOYEES NOC
8871 CLERICAL TELECOMMUTER EMPLOYEES.
The information noted above is as of 04/18/2025. For the most current information on the policy or to update your account information, please log into your account at www.bwc.ohio.gov. You may also call 1-800-644-6292 to speak with a customer service representative.
File details come from the government source that posted it. Updated .