forms header
Contractor's Certification of Worker's Compensation

Download the Contractor's Certification of Workers' Compensation*

§ 58. 1 -3714, Code of Virginia, provides in pertinent part:

B. 1. The governing body of any county, city or town shall not issue or reissue a business license under this chapter to any contractor who (i) has not obtained or is not maintaining workers' compensation coverage for his employees and (ii) at the time of application for such issuance or reissuance, is required to obtain or maintain such coverage pursuant to Chapter 8 (§ 65.2-800 et seq.) of Title 65.2.

2. Each such governing body shall require every contractor to provide written certification at the time of any application for issuance or reissuance of a business license that such contractor is in compliance with the provisions of Chapter 8 of Title 65.2 and will remain in compliance with such provisions at all times during the effective period of any such business license.

3. The governing body of any county, city or town shall forward such signed certification to the Virginia Workers' Compensation Commission, who shall conduct periodic audits of selected contractors to whom such body has issued business licenses to ensure the compliance of such contractors with the requirements of this subsection and the provisions of Chapter 8 of Title 65.2.

4. Any person who knowingly presents or causes to be presented to the governing body a false certificate shall be guilty of a Class 3 misdemeanor.

D. For the purpose of license taxation pursuant to §58.1-3703, the term ''contractor'' means any person, firm or corporation:

1. Accepting or offering to accept orders or contracts for doing any work on or in any building or structure, requiring the use of paint, stone, brick, mortar, wood cement, structural iron or steel, sheet iron, galvanized iron, metallic piping, tin, lead, or other metal or any other building material;

2. Accepting or offering to accept contracts to do any paving, curbing or other work on sidewalks, streets, alleys, or highways, or public or private property, using asphalt, brick, stone, cement, concrete, wood or any composition; 3. Accepting or offering to accept an order for or contract to excavate earth, rock, or other material for foundation or any other purpose or for cutting, trimming or maintaining rights-of-way;

4. Accepting or offering to accept an order or contract to construct any sewer of stone, brick, terra cotta or other material;

5. Accepting or offering to accept orders or contracts for doing any work on or in any building or premises involving the erecting, installing, altering, repairing, servicing, or maintaining electric wiring, devices or appliances permanently connected to such wiring, or the erecting, repairing or maintaining of lines for the transmission or distribution of electric light and power; or

6. Engaging in the business of plumbing and steam fitting.


If you are uncertain regarding your legal duty to obtain and maintain a policy of workers' compensation insurance, you are encouraged to consult the following before executing this certificate:

  1. Workers' Compensation Requirements for Employers in Virginia, published by the Virginia Workers' Compensation Commission and available at no charge from the commission or from your local Commissioner of Revenue:
  2. Your insurance agent or attorney;
  3. The Insurance Department of the Virginia Workers' Compensation Commission, which may be reached by telephone at (804) 367-2071.

If you are a licensed business intending to perform as a contractor within the City of Richmond you must submit the Contractor's Certification of Workers' Compensation.

Submit Application with Appropriate Materials to:
Division of License, Assessment and Tax Audit
900 E. Broad Street, Room 103
Richmond, VA 23219

Please print the form on white paper and sign to help us process your application in a timely manner.
If you need further instructions, please call (804) 646-5690.

*Note: In order to view and print these documents, your computer must have the Adobe Acrobat Reader utility installed; if this software is not installed on your system, you can download it for free from Adobe.
  900 East Broad Street, Richmond, Virginia 23219 (804)646-7000 Contact Us. The City of Richmond Virginia.
  ©2000-2008 City of Richmond, Virginia. All rights reserved. Privacy, Disclaimer & Terms.