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How do I fill this out?
Filling out this form is straightforward. Begin by entering your contractor details accurately in the provided sections. Ensure you check the appropriate exemption status before signing and submitting.
How to fill out the Workers' Compensation Coverage Exemption Form?
1
Enter your business information: name, contact name, email, phone number, and mailing address.
2
Select whether you are a Licensed or Unlicensed General Contractor and provide your license number if applicable.
3
Certify your exemption status by checking the relevant statement in the form.
4
Sign and date the form to confirm the information is accurate.
5
Submit the completed form via email to field.services@raleighnc.gov.
Who needs the Workers' Compensation Coverage Exemption Form?
1
Contractors with fewer than three employees need this form to certify their exemption from Workers' Compensation insurance.
2
Unlicensed general contractors must complete the form to demonstrate their compliance with state laws.
3
Business owners applying for permits involving construction use this form to confirm exemption status.
4
Freelancers or sole proprietors seeking building permits may require this form if they hire temporary help.
5
New contractors starting their business can use this form to clarify their insurance obligations.
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1
Access the form on PrintFriendly and choose the edit option.
2
Click on any field to make changes or add your information.
3
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4
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5
Download the edited PDF for your records or to submit.
What are the instructions for submitting this form?
To submit the Workers' Compensation Coverage Exemption form, email the completed document to field.services@raleighnc.gov. Ensure you have signed the form before submission. If you prefer, you can also contact the customer service center by phone at 919-996-2500 for further instructions.
What are the important dates for this form in 2024 and 2025?
Ensure to recertify your Workers' Compensation exemption status every January 1 for the duration of your construction permits. Keep track of state law changes that may affect your exemption status. Stay updated with any notifications from the City of Raleigh regarding compliance requirements.
What is the purpose of this form?
The purpose of this form is to allow eligible contractors to certify their exemption from Workers' Compensation insurance. It is essential for legal compliance, particularly for those with fewer than three employees. By submitting this form, contractors help protect both themselves and their clients under state law.
Tell me about this form and its components and fields line-by-line.
- 1. Business Name: The legal name of the contractor's business.
- 2. Contact Name: The individual completing the form.
- 3. Email Address: The contact email for follow-up.
- 4. Phone Number: The primary contact number for the contractor.
- 5. Mailing Address: The physical address for correspondence.
- 6. City: The city where the business is located.
- 7. State: The state of operation.
- 8. Zip Code: The postal code for the mailing address.
- 9. License Number: The contractor's license number if applicable.
- 10. Signature: An electronic or handwritten signature for validation.
- 11. Date: The date when the form is signed.
What happens if I fail to submit this form?
If the form is not submitted, contractors may face legal penalties. It is crucial to comply with state laws regarding Workers' Compensation insurance for contractors. Submitting the form is essential to avoid violations.
- Legal Penalties: Failing to submit the exemption may result in fines and other legal issues.
- Insurance Liabilities: Not having the form on file may expose the contractor to risk if an accident occurs.
- Permit Restrictions: Failure to provide necessary documentation can lead to issues obtaining construction permits.
How do I know when to use this form?
- 1. Permit Applications: Needed for contractors applying for construction permits.
- 2. Exemption Certification: For those seeking to confirm their exemption status from Workers' Compensation.
- 3. Legal Compliance: Used to ensure adherence to North Carolina's Workers' Compensation laws.
Frequently Asked Questions
Who needs to fill out this form?
Contractors with fewer than three employees, unlicensed general contractors, and anyone applying for a construction permit need to complete this form.
How do I submit this form?
You can email the completed form to field.services@raleighnc.gov.
Can I edit this form online?
Yes, PrintFriendly allows you to edit the PDF directly in your browser before downloading.
Is there a fee to submit this form?
There is no fee associated with submitting the Workers' Compensation Coverage Exemption form.
What happens if I don't submit this form?
Failure to submit may lead to violations of state law concerning Workers' Compensation insurance.
How can I ensure my information is accurate?
Take time to review all entries and follow instructions given on the form to confirm accuracy.
Can I save changes to the PDF document?
Yes, after making edits to the PDF on PrintFriendly, you can save the changes.
Is electronic signing accepted?
Yes, PrintFriendly allows for electronic signatures, which are accepted for legal purposes.
What should I do if my situation changes?
If you employ more than three people, you must provide a Certificate of Insurance.
How often should I recertify my exemption?
You are required to recertify your exemption status annually by January 1st.
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