Highspire, PA · Dauphin County
Workers’ Compensation Insurance Coverage Affidavit
The Workers’ Compensation Insurance Coverage Affidavit records an applicant’s insurance details or exemption claim for the Borough of Highspire when applying for a project.
- 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
The affidavit identifies whether the applicant is a property owner or a contractor and, when applicable, collects workers’ compensation insurer and policy information. Highspire’s form requires notarization for a contractor or applicant claiming an exemption as a sole proprietorship without employees or for employees exempt on religious grounds; religious exemption claims also require copies of the employees’ religious letters. A property owner performing their own work signs and dates the form without notarization.
Who needs it
Property owners and contractors applying in Highspire may need this affidavit, with contractors also providing workers’ compensation details and documentation for subcontractors.
Why it needs a notary
The validation block says the applicant swears and subscribes before a notary; the contractor or applicant signs before the notary when claiming a notarized exemption.
How to get this notarized
- 1
Download the Affidavit
Get Highspire’s Workers’ Compensation Insurance Coverage Affidavit.
- 2
Fill In Applicable Sections
Identify whether you are a property owner or contractor and complete the relevant insurance or exemption information.
- 3
Book an Online Notary
Schedule a remote session with a commissioned online notary if your exemption claim requires notarization.
- 4
Sign on Video
Sign during the online session and complete the sworn and subscribed validation with the notary.
- 5
Submit to the Borough
Provide the completed affidavit and any required supporting documents to the Borough of Highspire.
Preview the form
The blank PDF straight from Highspire. 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
- Who uses Highspire’s workers’ compensation affidavit?
- Property owners and contractors applying in Highspire use the form to identify their applicant type, provide insurance information when applicable, or state a listed exemption.
- Do I need to have this affidavit notarized?
- The form calls for notarization for a sole proprietorship without employees and for a religious-ground exemption. A property owner performing their own work signs and dates the form only.
- How do I complete the affidavit with an online notary?
- Fill in the applicable sections, book a session with a commissioned online notary, and sign during the video session. Include copies of religious letters for all employees when claiming that exemption.
- Can I sign this form remotely?
- Pennsylvania law authorizes remote online notarization by a commissioned online notary under 57 Pa.C.S. §306.1. The form must still meet the Borough’s submission requirements; confirm with the city, borough or township if unsure.