Springville, NY · Erie County
Insured Contractor Form
Contractors use this form to provide business and ownership details to the Village of Springville and submit the required insurance or workers’ compensation documentation.
What this form is
The Insured Contractor Form records a contractor’s business and contact information, identification number, and principal owners or officers for the Village of Springville. Contractors are instructed to include a disability and workers’ compensation insurance certificate or a workers’ compensation exemption certificate; new insurance certificates must be sent annually at renewal to keep the license current.
Who needs it
Contractors submitting their business details to the Village of Springville should use this form and include the specified insurance certificate or exemption certificate.
How to submit it
Return the completed form to the Village of Springville, PO Box 17, Springville, NY 14141. Include a disability and workers’ compensation insurance certificate or a workers’ compensation exemption certificate.
About notarization
This document is signed without a notary; the required insurance or workers’ compensation exemption certificate is not described as notarized, and the signer signs and dates the form.
How to submit this form
- 1
Download the Form
Download the Insured Contractor Form PDF.
- 2
Complete the Form
Print the form and provide the business, identification, address, contact, and principal owner or officer information.
- 3
Gather Required Documentation
Include a disability and workers’ compensation insurance certificate or a workers’ compensation exemption certificate.
- 4
Sign and Date
Sign and date the completed form; the form does not have a notary block.
- 5
Return It to the Village
Mail the form and required documentation to the Village of Springville, PO Box 17, Springville, NY 14141.
Frequently asked questions
- Do I need a notary for the Insured Contractor Form?
- No. The form has a signature and date line but no notary block. The required insurance or workers’ compensation exemption certificate is not described as notarized.
- How do I submit the Insured Contractor Form?
- Return the completed form to the Village of Springville, PO Box 17, Springville, NY 14141, with the required insurance certificate or workers’ compensation exemption certificate.
- What documents must I include with the form?
- Include a certificate of insurance for disability and workers’ compensation, or a workers’ compensation exemption certificate.
- When must new insurance certificates be sent?
- The form says new certificates of insurance must be sent annually at the time of renewal to keep the license current.