Spring Lake, NC · Cumberland County
Affidavit of Worker's Compensation Coverage
Contractors, owners, or their officers or agents submit this affidavit with a Spring Lake building permit to state workers' compensation coverage details.
What this form is
This affidavit accompanies a building permit application and records the workers' compensation coverage situation for the people or businesses performing the permitted work. The contractor, owner, or their officer or agent identifies the firm, signs, states a title, and dates the affidavit. The Inspection Department may require certificates of insurance coverage before issuing the permit or during permitted work.
Who needs it
A contractor, owner, or their officer or agent applying for a Spring Lake building permit for work covered by the affidavit should complete it.
How to submit it
Submit it to the Inspection Department issuing the building permit; the affidavit says that department may require insurance certificates before issuance and during permitted work.
About notarization
This affidavit is signed and dated without a notary; the signer affirms the coverage information under penalties of perjury.
How to submit this form
- 1
Download The Affidavit
Download the worker's compensation coverage affidavit for the building permit.
- 2
Complete The Affidavit
Enter the permit number and firm name, describe the applicable coverage, and provide the signer's title and date.
- 3
Sign And Date
The contractor, owner, or their officer or agent signs and dates the affidavit.
- 4
Submit To The Inspection Department
Submit the affidavit to the Inspection Department issuing the building permit. The department may require coverage certificates.
Frequently asked questions
- Who completes the worker's compensation coverage affidavit?
- The applicant for a building permit completes it. The document identifies the applicant as the contractor, owner, or an officer or agent of the contractor or owner.
- What information does the affidavit request?
- It asks for the building permit number, the firm's name, the signer's title and date, and an affirmation describing workers' compensation coverage for those performing the work.
- Do I need a notary for this affidavit?
- No. This affidavit is signed and dated without a notary; the signer affirms the coverage information under penalties of perjury.
- How do I submit the affidavit?
- Submit it to the Inspection Department issuing the building permit. The department may require certificates of workers' compensation coverage before issuing the permit or during permitted work.
Need something notarized?
This Affidavit of Worker's Compensation Coverage doesn’t need a notary — but if you have another Spring Lake form that does, a commissioned online notary can help.