Morrisville, NC · Wake County
Affidavit of Workers’ Compensation Coverage
Contractors, owners, or their officers or agents complete this affidavit to report workers’ compensation coverage for work covered by a building permit.
What this form is
This affidavit records workers’ compensation coverage arrangements for people performing work under a building permit. The applicant identifies their role and selects the statement that describes employee and subcontractor coverage, then provides the firm name, signer’s name, title, and date. The Inspection Department may require certificates of insurance coverage before issuing the permit and at any time during permitted work.
Who needs it
A contractor, owner, or their officer or agent applying for a building permit for work performed by employees or subcontractors needs 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 document is signed and dated without a notary; the signer makes the statement under penalties of perjury, and no notarized attachment is identified.
How to submit this form
- 1
Download The Affidavit
Download the Affidavit of Workers’ Compensation Coverage PDF.
- 2
Complete The Applicant Details
Enter the building permit number and identify yourself as the contractor, owner, or an officer or agent.
- 3
Select The Coverage Statement
Mark the statement that describes employee and subcontractor workers’ compensation coverage.
- 4
Sign And Submit
Provide the firm name, signature, title, and date, then submit the affidavit to the city department named on the form.
Frequently asked questions
- Who completes the Affidavit of Workers’ Compensation Coverage?
- The building permit applicant completes it as a contractor, owner, or officer or agent of the contractor or owner.
- What information does the affidavit request?
- It asks for the building permit number, applicant role, workers’ compensation coverage situation, firm name, signer’s name, title, and date.
- Do I need a notary for the Affidavit of Workers’ Compensation Coverage?
- No. The document is signed and dated without a notary, though the signer makes the statement under penalties of perjury.
- How do I submit the affidavit?
- Submit it to the city department named on the form; 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 Morrisville form that does, a commissioned online notary can help.