Connecticut Form 7B PDF Details

In the State of Connecticut, a unique form titled "7B Proof of Workers’ Compensation Coverage" plays a critical part in the process of applying for a building permit, specifically for those individuals stepping into the roles of general contractors or principal employers on their construction projects. This document, part of the broader regulatory environment governed by the State of Connecticut Workers’ Compensation Commission, stipulates stringent requirements for the proof of workers' compensation insurance. The form caters to a very specific group: sole proprietors and property owners who decide to take on these roles for construction work taking place on their properties. It outlines a dual-path approach for compliance, where an individual must either provide direct proof of insurance coverage for all employees involved in the project or submit an affidavit that verifies their commitment to requiring such proof from all contractors or subcontractors engaged in the work. Revised on March 17, 2006, the form requires detailed inputs from the applicant, including a notarized signature, thereby underpinning its legal significance and the seriousness with which the commission and the state as a whole view workplace safety and insurance coverage. Beyond its immediate practical implications for construction project management, the Connecticut 7B form encapsulates broader commitments to workers' rights, workplace safety, and regulatory compliance, making it an essential document for many in the state undertaking construction projects.

QuestionAnswer
Form Name Connecticut Form 7B
Form Length 1 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 15 sec
Other names Proprietor, 7b form, 31-286b, abovenamed, connecticut workers’ compensation commission

Form Preview Example

State of Connecticut Workers’ Compensation Commission

Please TYPE or PRINT IN INK

Rev. 3-17-2006

7B

Proof of Workers’ Compensation Coverage when Applying

for a Building Permit for the Sole Proprietor or Property Owner who WILL act as General Contractor or Principal Employer

APPLICANT FOR BUILDING PERMIT

Name of Applicant for Building Permit

Property located at

in the City / Town of

ATTEST

If you are the owner of the above-named property or the sole proprietor of a business doing work on the site of the construction project at the above-named property and you WILL act as the general contractor or principal employer, you must provide proof of workers’ compensation insurance coverage for all employees.

Complete this form and, if applicable, sign the Affidavit below in the presence of a Notary Public or a Commissioner of the Superior Court.

CHECK ONE (1) BOX ONLY, provide the appropriate information, and sign:

I am the OWNER of the above-named property. I WILL act as the general contractor or principal employer and, as such, will submit proof of workers’ compensation insurance coverage for all employees who are doing work on the site of the construction project at the above-named property.

Signature of OWNER Applicant

I am the SOLE PROPRIETOR of a business doing work at the above-named property. I WILL act as the general contractor or principal employer and, as such, will submit proof of workers’ compensation insurance coverage for all employees who are doing work on the site of the construction project at the above- named property.

Signature of SOLE PROPRIETOR Applicant

I am the OWNER of the above-named property or the SOLE PROPRIETOR of a business doing work at the above-named property. I will not personally submit proof of workers’ compensation insurance coverage, but I will attest to the following:

AFFIDAVIT

I hereby swear and attest that I will require proof of workers’ compensation insurance for every contractor, subcontractor, or other worker before he or she does work on the site of the construction project at the above-named property in accordance with Section 31-286b of the Workers’ Compensation Act.

Signature of OWNER or SOLE PROPRIETOR Applicant

Name of Business—if applicable

Federal Employer ID# (FEIN)—if applicable

Subscribed and sworn to before me this

 

day of

 

, 200

 

.

Signature of Notary Public / Commissioner of the Superior Court

How to Edit Connecticut Form 7B Online for Free

Should you desire to fill out Notary, you don't need to download any kind of software - simply try using our online tool. FormsPal team is devoted to providing you the perfect experience with our editor by continuously releasing new functions and upgrades. Our tool has become much more useful with the latest updates! So now, editing PDF files is simpler and faster than ever. All it takes is a couple of easy steps:

Step 1: Press the "Get Form" button in the top area of this webpage to open our editor.

Step 2: Using our advanced PDF editing tool, it's possible to accomplish more than just fill in forms. Express yourself and make your documents appear perfect with custom text put in, or modify the original input to perfection - all supported by an ability to incorporate your own pictures and sign the PDF off.

To be able to complete this document, be sure to provide the right details in each blank:

1. Start completing the Notary with a group of essential blank fields. Collect all of the necessary information and be sure not a single thing forgotten!

Subscribed writing process detailed (portion 1)

2. When this selection of blank fields is completed, proceed to enter the relevant details in these: Signature of OWNER or SOLE, Name of Businessif applicable, Federal Employer ID FEINif, Subscribed and sworn to before me, day of, and Signature of Notary Public.

Completing segment 2 of Subscribed

It is possible to make errors when filling out your Federal Employer ID FEINif, hence be sure to go through it again before you'll finalize the form.

Step 3: As soon as you have reviewed the details you given, press "Done" to finalize your form. After creating afree trial account here, you'll be able to download Notary or send it via email right off. The PDF document will also be readily accessible through your personal cabinet with all your changes. When using FormsPal, you can fill out forms without worrying about information leaks or entries being distributed. Our protected system helps to ensure that your personal data is stored safely.