Do I need a notary for the Workers’ Compensation Coverage Affidavit?

No. The document has no notary block; the signer affirms the information under penalties of perjury and signs and dates the affidavit.

Who completes the Workers’ Compensation Coverage Affidavit?

The applicant for the building permit completes it as a contractor, owner, or officer or agent of the contractor or owner.

What information does the affidavit ask for?

It asks about the applicant’s role and workers’ compensation coverage for employees and subcontractors, plus the qualifier’s printed name, signature, date, and company name if applicable.

How do I submit the Workers’ Compensation Coverage Affidavit?

The form lists City of Sanford at 115 Chatham St., Suite 1, Sanford, NC 27330, and names the Inspection Department, but does not specify a filing method.

Sanford, NC · Lee County

No notary required

Workers’ Compensation Coverage Affidavit

Contractors, owners, or their agents submit this affidavit with a Sanford building permit application to affirm workers’ compensation coverage for the project.

What this form is

This affidavit accompanies a City of Sanford building permit application and lets the applicant identify their role and affirm the workers’ compensation coverage status of the people doing the work. It asks about employees and subcontractors, and requires the qualifier’s printed name, signature, date, and company name if applicable. The Inspection Department may require certificates of coverage before issuing the permit or while permitted work is underway.

Who needs it

A contractor, owner, or officer or agent of either completing a City of Sanford building permit application uses this affidavit.

How to submit it

The form lists City of Sanford, 115 Chatham St., Suite 1, Sanford, NC 27330, and phone and fax numbers. It names the Inspection Department but does not specify a filing method.

About notarization

This document is signed without a notary; the signer affirms the coverage information under penalties of perjury, and no notarized attachment or related step is identified.

How to submit this form

1
Download The Affidavit
Download the Workers’ Compensation Coverage Affidavit for the Sanford building permit application.
2
Complete The Affidavit
Identify whether you are the contractor, owner, or an officer or agent, and affirm the applicable coverage information.
3
Sign And Date
Print the qualifier’s name, sign and date the affidavit, and provide the company name if applicable.
4
Submit With The Permit Application
Submit the affidavit to the city. The form lists the Inspection Department and the address at 115 Chatham St., Suite 1, Sanford.

Frequently asked questions

Do I need a notary for the Workers’ Compensation Coverage Affidavit?: No. The document has no notary block; the signer affirms the information under penalties of perjury and signs and dates the affidavit.
Who completes the Workers’ Compensation Coverage Affidavit?: The applicant for the building permit completes it as a contractor, owner, or officer or agent of the contractor or owner.
What information does the affidavit ask for?: It asks about the applicant’s role and workers’ compensation coverage for employees and subcontractors, plus the qualifier’s printed name, signature, date, and company name if applicable.
How do I submit the Workers’ Compensation Coverage Affidavit?: The form lists City of Sanford at 115 Chatham St., Suite 1, Sanford, NC 27330, and names the Inspection Department, but does not specify a filing method.

Need something notarized?

This Workers’ Compensation Coverage Affidavit doesn’t need a notary — but if you have another Sanford form that does, a commissioned online notary can help.