Greencastle, PA · Franklin County
Addendum to Zoning Permit (Workers’ Compensation Insurance Certification)
This addendum records workers’ compensation coverage or an exemption for a contractor or applicant seeking a zoning permit.
What this form is
Applicants for a zoning permit use this addendum to certify workers’ compensation insurance or claim an exemption. It asks for insurer, policy, contractor, and applicant information, or the basis for exemption, and requires a signature; insurance or self-insurance certificates must be attached when selected.
Who needs it
A contractor or applicant for a zoning permit completes this addendum to document coverage or claim an exemption.
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; the signer verifies the statements under penalty for unsworn falsifications, and selected insurance certificates must be attached.
How to submit this form
- 1
Download The Form
Download the workers’ compensation certification addendum for the zoning permit.
- 2
Complete The Applicable Sections
Select an insurance certificate, self-insurance certificate, or exemption, then complete the corresponding sections and signer information.
- 3
Gather Required Attachments
Attach a certificate of insurance or self-insurance if you selected that option.
- 4
Sign And Submit
Sign the form and submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What is the Greencastle workers’ compensation certification?
- It is an addendum to a zoning permit where the applicant provides workers’ compensation insurance information or states a basis for exemption.
- What should I attach to the form?
- If you select a certificate of insurance or certificate of self-insurance, attach that certificate. The form directs you to complete Sections II and IV for either option.
- Do I need a notary for the workers’ compensation certification?
- No. The document is signed without a notary; the signer verifies the statements under penalty for unsworn falsifications. Attach an insurance certificate if you select that option.
- How do I submit the workers’ compensation certification?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Addendum to Zoning Permit (Workers’ Compensation Insurance Certification) doesn’t need a notary — but if you have another Greencastle form that does, a commissioned online notary can help.