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Ct workers' compensation claimant's affidavit

Division stamford compensation download 2026

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The document is a Workers' Compensation Coverage Affidavit from the City of Stamford's Building Inspection Division, requiring permit applicants to verify compliance with Connecticut Workers' Compensation Laws. It outlines options for homeowners, sole proprietors, contractors, and corporate officers regarding their responsibilities for ensuring workers on construction projects have appropriate insurance coverage. The affidavit emphasizes the legal obligations and potential penalties for misrepresentation of employer status.

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Click ‘Get Form’ to open the division stamford compensation download in the editor.
Begin by entering the project identification details. Fill in the property owner's name, street address, apartment/unit number, section of the city, and CT zip code.
In the 'Description of Work' section, provide a brief overview of the work being performed on the property.
Select one option from the provided choices (Homeowner, Sole Proprietor, Contractor, Corporate Officer or Business Partner) that best describes your role in this project. Ensure you fill in your name where indicated.
If applicable, attach any required documents such as a Certificate of Insurance or Commission’s exemption certificate by using our platform's upload feature.
Finally, sign and date the affidavit at the bottom of the form. You may also need to have it notarized as indicated.

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A Welcome to Stamford in 1996, which replaced the motto Moving Forward With People with The City That Works.

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Average City of Stamford hourly pay ranges from approximately $16.99 per hour for Program Assistant to $46.46 per hour for Head Custodian. The average City of Stamford salary ranges from approximately $35,100 per year for Laborer to $149,776 per year for Director.

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