West Reading, PA · Berks County
Pennsylvania Workers’ Compensation Insurance Coverage Information Form
Homeowners and contractors complete this form with a building or zoning permit application to provide workers’ compensation coverage information for work in West Reading.
What this form is
West Reading requires this form with a requested building or zoning permit; the permit will not be issued until the form is completed properly. Homeowners indicate whether they will perform the work themselves, while contractors provide company and contact details, identify their coverage or exemption, and report any subcontractors. Contractors may need to attach an insurance certificate.
Who needs it
Homeowners performing work themselves and contractors hired for a project complete the form with the building or zoning permit application.
How to submit it
Submit the completed form with your building or zoning permit application to the Code Enforcement Department, 500 Chestnut Street, West Reading, PA 19611.
About notarization
This document is signed and dated without a notary; the signer signs the applicable homeowner or contractor statement.
How to submit this form
- 1
Download The Form
Download the West Reading Workers’ Compensation Insurance Coverage Information Form.
- 2
Complete Applicable Sections
Answer the homeowner or contractor questions and complete the applicable company, coverage, exemption, and subcontractor information.
- 3
Gather Required Documentation
If applicable, attach an insurance certificate; the form also states that subcontractors must present proof of insurance.
- 4
Submit With Your Permit Application
Submit the completed form with your building or zoning permit application to the Code Enforcement Department.
Frequently asked questions
- Who completes the West Reading workers’ compensation form?
- Homeowners performing project work themselves and contractors hired by the homeowner or property owner complete the applicable sections with the permit application.
- Do I need a notary for the Workers’ Compensation Coverage Information Form?
- No. This document is signed and dated without a notary; the signer signs the applicable homeowner or contractor statement.
- How do I submit the Workers’ Compensation Coverage Information Form?
- Submit the completed form with your building or zoning permit application to the Code Enforcement Department at 500 Chestnut Street, West Reading, PA 19611.
- Do contractors need to attach proof of insurance?
- The form asks qualified self-insurers to attach an insurance certificate listing the municipality as a certificate holder. Subcontractors must present proof of insurance as required by the form.