Laureldale, PA · Berks County
Worker’s Compensation Affidavit
This affidavit is for contractors seeking a Laureldale building permit who state they will not hire other people for the permitted project.
What this form is
Contractors seeking building permits in Laureldale use this affidavit to state that they will not employ or hire anyone for the project. If they later hire someone, the form says they must notify the borough office and provide proof of workers’ compensation coverage within three working days. It asks for the signer’s name, signature, contractor or business name, and date, and is valid for one year from signing.
Who needs it
Contractors seeking a Laureldale building permit who will not hire other people for the project complete and sign 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 without a notary; it contains a sworn statement, and the signer signs and dates it.
How to submit this form
- 1
Download The Affidavit
Download the Worker’s Compensation Affidavit PDF.
- 2
Complete The Statement
Enter your name and contractor or business name, then sign and date the affidavit.
- 3
Review The Requirements
Review the form’s statement about notifying the borough office and providing coverage proof if you hire anyone.
- 4
Submit To The City
Submit the completed 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 Worker’s Compensation Affidavit?
- No. The document has no notary block; it contains a sworn statement that the signer signs and dates.
- Who should complete this affidavit?
- A contractor seeking a Laureldale building permit who states they will not hire or employ other people for the project should complete it.
- What if I hire someone after receiving the building permit?
- The form says to notify the borough office and provide proof of workers’ compensation coverage within three working days.
- 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 Worker’s Compensation Affidavit doesn’t need a notary — but if you have another Laureldale form that does, a commissioned online notary can help.