Angier, NC · Harnett County
Affidavit of Worker’s Compensation Coverage
Contractors, owners, or their agents complete this affidavit for work covered by an Angier building permit to report workers’ compensation coverage.
What this form is
This affidavit accompanies an application for an Angier building permit and identifies the workers’ compensation coverage status of the people or businesses performing the permitted work. The signer selects the statement that applies to the employees and subcontractors, then provides the firm name, signer’s name, title, and date. The Inspections Department may require coverage certificates or waivers before issuing the permit or while work is underway.
Who needs it
A contractor, property owner, or contractor or owner’s officer or agent seeking a building permit for work in Angier completes this affidavit.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This affidavit is signed and dated without a notary; the signer provides the firm name and title, and the document identifies no notarized attachment.
How to submit this form
- 1
Download The Affidavit
Download the Affidavit of Worker’s Compensation Coverage PDF.
- 2
Complete The Affidavit
Select the statement that applies to the employees and subcontractors performing the permitted work; enter the firm name, signer, title, and date.
- 3
Gather Coverage Documents
The Inspections Department may require certificates of coverage or waivers before permit issuance or during permitted work.
- 4
Submit To The City
Submit the affidavit to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Who completes the workers’ compensation affidavit?
- The building permit applicant completes it as a contractor, owner, or officer or agent of the contractor or owner. The signer provides the firm name, name, title, and date.
- What information does the affidavit request?
- It asks the applicant to identify the applicable workers’ compensation coverage situation for employees and subcontractors, then provide the firm name, signer, title, and date.
- Do I need a notary for the workers’ compensation affidavit?
- No. This affidavit is signed and dated without a notary; the form asks for the firm name and signer’s title and identifies no notarized attachment.
- How do I submit the affidavit?
- The document does not provide submission instructions. Submit it to the city department named on the form and check the city website for current contact details.
Need something notarized?
This Affidavit of Worker’s Compensation Coverage doesn’t need a notary — but if you have another Angier form that does, a commissioned online notary can help.