Carrboro, NC · Orange County
Affidavit of Workers’ Compensation Coverage
Contractors, owners, or their agents use this affidavit to report workers’ compensation coverage for work covered by a Carrboro building permit.
What this form is
This affidavit records the applicant’s statement about workers’ compensation coverage for people performing work under a building permit. The applicant identifies whether the work involves employees or subcontractors and indicates the applicable coverage situation. The Inspections Division may require certificates of coverage or waivers before issuing the permit and at any time during the permitted work.
Who needs it
A building permit applicant who is a contractor, owner, or their officer or agent completes the affidavit for the permitted work.
How to submit it
The form names the Town of Carrboro Inspections Division and gives its address as 301 W. Main Street, Carrboro, NC 27510. Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This affidavit has no notary block, so the signer signs and dates it; the document does not identify any attachment or related step that must be notarized or sworn.
How to submit this form
- 1
Download The Affidavit
Download the Affidavit of Workers’ Compensation Coverage PDF.
- 2
Complete The Affidavit
Identify your role and mark the statement that applies to employees, subcontractors, and coverage.
- 3
Add Firm And Signer Details
Print the firm name, then provide the signer’s name, title, and date.
- 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
- Do I need a notary for the Workers’ Compensation Coverage Affidavit?
- No. The affidavit has no notary block; the signer signs and dates it. The form does not identify any attachment or related step that must be notarized or sworn.
- Who completes this affidavit?
- The building permit applicant 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 employees, subcontractors, and workers’ compensation coverage, and requests the firm name, signer, title, and date.
- How do I submit the affidavit?
- The form names the Town of Carrboro Inspections Division at 301 W. Main Street, Carrboro, NC 27510. Check the city website for current contact details.
Need something notarized?
This Affidavit of Workers’ Compensation Coverage doesn’t need a notary — but if you have another Carrboro form that does, a commissioned online notary can help.