Andover, KS · Butler County
Contractor Insurance Exemptions
This form lets a licensed contractor declare exemptions from workers’ compensation insurance requirements and company-owned automobile insurance, and submit the sworn statements to the City of Andover.
At a glance
- Issued by
- City of Andover · Andover, Butler County, Kansas
- Notarization
- Required: sign this form in front of a notary before filing it.
- Official source
- andoverks.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
The two-part form is for a licensed contractor doing business in Andover to state that the contractor does not come under Kansas workers’ compensation insurance requirements and has no company-owned vehicles. It also states that business vehicles are covered by personal automobile insurance. The contractor promises to notify Andover’s Building Official if either status changes; the form includes a separate sworn statement for each exemption.
Who needs it
A licensed contractor doing business in Andover who is claiming the listed workers’ compensation and automobile insurance exemptions needs to complete the applicable statements.
Why it needs a notary
Each exemption section carries a “Subscribed and sworn to before me” jurat, which the contractor signs before the notary.
How to get this notarized
- 1
Download the Form
Get the Contractor Exemptions form from the City of Andover.
- 2
Complete the Applicable Statements
Enter your contractor and company information and complete the exemption statements that apply.
- 3
Book an Online Notary
Arrange an online notarization and confirm with the city if you are unsure whether it accepts a remotely notarized form.
- 4
Sign on Video
Sign each completed statement in the online notary’s presence so the notary can complete its jurat.
- 5
Submit to the City
Send the notarized form to the City of Andover as directed.
Preview the form
The blank PDF straight from Andover. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I complete the contractor exemption form?
- Complete the applicable contractor and company information, sign each statement before a notary, and submit the form to the City of Andover.
- Do I need to notarize both exemption statements?
- The form includes a separate “Subscribed and sworn to before me” jurat for each exemption. Sign each statement you complete before a notary.
- Can I use a commissioned online notary?
- Kansas authorizes remote online notarization by its notaries. Ask the City of Andover whether it accepts a remotely notarized copy of this form; confirm with the city if unsure.
- What if my insurance or vehicle status changes?
- The form says to notify the Building Official of Andover if your stated status changes.