Contractor Affidavit

This Affidavit certifies all required steps have been taken to perform construction or other work such as landscaping, electrical, plumbing or mechanical.

If COVID-19 Employee Certification Forms are not submitted with this form, they must be provided to the City or your work may be stopped.

Documents

COVID-19 Employee Certification Form - English (11.24.20) (180 KB)

COVID-19 Employee Certification Form - Español (11.24.20) (163 KB)

COVID-19 Guidelines for Work Safety Poster (3 MB)

Contractor Affidavit (11.24.20) (140 KB)

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Job Site Information

Permit Number (if applicable)

Site Address *

Company Name *

Contractor or Service Owner’s Name *

Contractor/Owner E-mail *

Contractor/Owner Phone *

COVID Supervisor Name *

COVID Supervisor Phone *

Certification

I certify I have met all of the requirements necessary to perform construction at the above referenced job.

Signature *

Please type your first and last name.

Acknowledgement *

By checking this box, I understand and agree to the above terms.

Worker Certification of Job Site Compliance

COVID-19 Employee Certification Forms *

Attached (upload below)

Will Deliver to Ketchum City Hall within 48 Hours

Upload Here

Files must be less than 2 MB.
Allowed file types: jpg jpeg pdf doc docx.

Contractor Affidavit

Documents

Contact Information

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