What is the Contractor’s Statement of Responsibility?

It records a contractor’s acknowledgment of the Quality Assurance Plan and special inspection program, and describes required quality-control procedures and personnel.

Who must submit this statement?

Each contractor responsible for constructing or fabricating a system or component designated in the Quality Assurance Plan must submit it.

Do I need a notary for the Contractor’s Statement of Responsibility?

No. The form calls for a signature and date, not notarization; attach the stated quality-control procedures and personnel qualifications.

How do I submit the statement?

Submit it to City of Salem Community Development Building Inspection. The form does not list an address, email, portal, or fee.

Salem, VA · City of Salem

No notary required

Contractor’s Statement of Responsibility

Contractors responsible for designated building systems or components submit this statement to acknowledge quality assurance and describe their quality-control provisions.

What this form is

Each contractor responsible for construction or fabrication of a system or component designated in the Quality Assurance Plan must submit this statement. It identifies the project, contractor, license number, and designated systems or components, and acknowledges the plan and special inspection requirements. The contractor also attaches quality-control procedures and information about the people responsible for exercising control.

Who needs it

Contractors responsible for constructing or fabricating systems or components designated in the Quality Assurance Plan need to submit this statement.

How to submit it

Submit it to City of Salem Community Development Building Inspection; the form gives no address, email, portal, or fee.

About notarization

This statement is signed and dated without a notary; required quality-control procedures and personnel qualifications are attached, with no notarized step stated.

How to submit this form

1
Download the Statement
Download the Contractor’s Statement of Responsibility PDF.
2
Complete the Form
Enter the project, contractor name, address, license number, and designated systems or components.
3
Gather Required Attachments
Attach the contractor’s quality-control procedures and information about the people exercising control and their positions.
4
Sign and Submit
Sign and date the statement, then submit it to City of Salem Community Development Building Inspection.

Frequently asked questions

What is the Contractor’s Statement of Responsibility?: It records a contractor’s acknowledgment of the Quality Assurance Plan and special inspection program, and describes required quality-control procedures and personnel.
Who must submit this statement?: Each contractor responsible for constructing or fabricating a system or component designated in the Quality Assurance Plan must submit it.
Do I need a notary for the Contractor’s Statement of Responsibility?: No. The form calls for a signature and date, not notarization; attach the stated quality-control procedures and personnel qualifications.
How do I submit the statement?: Submit it to City of Salem Community Development Building Inspection. The form does not list an address, email, portal, or fee.

Need something notarized?

This Contractor’s Statement of Responsibility doesn’t need a notary — but if you have another Salem form that does, a commissioned online notary can help.