Fuquay-Varina, NC · Wake County
Workers Compensation Compliance Affidavit
This affidavit verifies a licensed general contractor’s workers compensation insurance or exempt status for submission to the Inspection Department with the required insurance certificate.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
Licensed general contractors submit this compliance verification to the Inspection Department with an original Certificate of Insurance on an annual basis. The form lets the contractor certify insurance coverage for employees or subcontractors, or state an exempt status, and includes an undertaking to maintain required coverage during permitted construction. The form says it will not be accepted unless notarized; a lapse in required coverage may result in a stop work order.
Who needs it
Licensed general contractors seeking permits or maintaining permitted construction submit the verification and applicable insurance certificate to the Inspection Department annually.
Why it needs a notary
The form has a jurat stating it was sworn to and subscribed before a notary; the licensed general contractor holding the license signs before the notary.
How to get this notarized
- 1
Download the Form
Get the Workers Compensation Compliance Affidavit from the city’s document center.
- 2
Complete the Form
Select and complete the certification that applies to your employees, subcontractors, insurance, or exempt status.
- 3
Book an Online Notary
Arrange an appointment with a commissioned online notary and confirm the city accepts online notarization.
- 4
Sign on Video
Sign the affidavit before the notary during your online appointment.
- 5
Submit to the City
Attach the applicable insurance certificate and submit the notarized affidavit to the Inspection Department.
Preview the form
The blank PDF straight from Fuquay-Varina. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I submit the Workers Compensation Compliance Affidavit?
- Complete and notarize the affidavit, attach the applicable Certificate of Insurance, and submit them to the Inspection Department. The form calls for an original certificate and annual submission.
- Do I need to attach a Certificate of Insurance?
- The form instructs contractors verifying insurance coverage to provide a Certificate of Insurance showing coverage dates and listing the Inspection Department for notification if coverage lapses.
- Can I notarize this form online?
- North Carolina’s remote electronic notarization program has not launched. Rush Notary can help arrange a commissioned online notary where accepted; confirm the city will accept online notarization before booking.
- What if I am claiming exempt status?
- The form includes statements for contractors with no more than two employees and no subcontractors. Check the applicable certification and confirm with the city or town if unsure.