Apex, NC · Wake County
Affidavit of Workers' Compensation Coverage
Building permit applicants use this affidavit to report workers’ compensation coverage and subcontractor status for work covered by the permit.
What this form is
A building permit applicant completes this affidavit to report workers’ compensation coverage for the contractor and subcontractors performing the permitted work. The form asks the applicant to identify their role, select statements about employee and subcontractor coverage, and provide the firm name, printed name, title, signature, and date. The Inspection Department may require certificates of coverage before issuing the permit or during the permitted work.
Who needs it
The contractor, owner, or contractor’s or owner’s officer or agent applying for a building permit completes this affidavit.
How to submit it
Submit the completed affidavit to Town of Apex Building Inspections and Permitting. The form lists [email protected] and 919-249-3418.
About notarization
This affidavit is signed and dated without a notary; the document does not identify a notarized or sworn attachment or related step.
How to submit this form
- 1
Download The Affidavit
Download the Affidavit of Workers' Compensation Coverage PDF.
- 2
Complete The Form
Enter the building permit number, identify your role, select the applicable contractor and subcontractor statements, and fill in the requested details.
- 3
Gather Coverage Certificates
The Inspection Department may require certificates of workers' compensation coverage before permit issuance or during the permitted work.
- 4
Submit To The City
Submit the affidavit to Town of Apex Building Inspections and Permitting; the form lists an email address and phone number.
Frequently asked questions
- Do I need a notary for the Affidavit of Workers' Compensation Coverage?
- No. The form has a signature and date line but no notary block. The document does not identify a notarized or sworn attachment or related step.
- Who completes this workers' compensation affidavit?
- The building permit applicant completes it. The form identifies the applicant as the contractor, owner, or an officer or agent of the contractor or owner.
- What information does the affidavit ask for?
- It asks the applicant to select statements about the general contractor's employees and subcontractor coverage, then provide the firm name if applicable, printed name, title, signature, and date.
- How do I submit the affidavit?
- Submit it to Town of Apex Building Inspections and Permitting. The form lists [email protected] and 919-249-3418 as contact details.
Need something notarized?
This Affidavit of Workers' Compensation Coverage doesn’t need a notary — but if you have another Apex form that does, a commissioned online notary can help.