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Affirmation of Compliance

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STATE OF NEVADA, DIVISION OF INDUSTRIAL RELATIONS

AFFIRMATION OF COMPLIANCE

WITH MANDATORY INDUSTRIAL INSURANCE REQUIREMENTS

(Instructions with Definitions are located on reverse side)

Identified as: (Complete one section only)

I declare that I have the authority to act on behalf of the above described business, and am applying for a license to operate said business as a(n):

I do hereby affirm that the above information is true and correct.

DATED this day of , 20

If unable to sign this document in the presence of a Business License Employee, the Applicant's signature must be notarized.

SUBSCRIBED and SWORN to before me on this day of , 20
D-25(1) (rev. 3/01)

INSTRUCTIONS

The provisions of Chapter 616A to D, inclusive, of the Nevada Revised Statutes require every person, firm, voluntary association, and private corporation, including any public service corporation, which has any person, subcontractor, or independent contractor, under contract of hire, to obtain industrial insurance coverage in Nevada or obtain a certificate of self-insurance from the Nevada Commissioner of Insurance. Subcontractors and independent contractors engaged in the same trade, business, profession or occupation as the hiring person or business, are by law considered to be employees. One exception to the requirement for industrial insurance is if you or your business hires no employees, subcontractors or independent contractors. You are not required to obtain industrial insurance coverage for the following employees: theatrical or stage performers; casual musicians; household domestics, farm, dairy, agricultural or horticultural laborers, or persons engaged in stock or poultry raising; voluntary ski patrolman; real estate brokers and/or salesmen; direct sellers; or clergy. Businesses which elect to obtain industrial insurance coverage for such persons, gain valuable rights and significantly reduce liabilities for injuries to these persons. A business which hires persons who are exempt from the provisions of Chapter 616A to 617, inclusive, of the Nevada Revised Statutes may be held liable in tort for injuries to those persons. A business which hires exempt persons may elect to obtain industrial insurance, including sole proprietor coverage and partnerships.

IMPORTANT NOTICE: Pursuant to the provisions of NRS 616D.200(1): Any employer within the provisions of NRS 616B.633 who fails to provide, secure or maintain compensation as required by the terms of this chapter, is: (a) for the first offense, guilty of a misdemeanor and (b) for a second or subsequent offense committed within 7 years after the previous offense, guilty of a category D felony.

Definitions for Purposes of this Affirmation:

  • "Applicant" is the person executing this document.
  • "Business Name" is the name under which the business will operate, including the identification of any other names under which the entity will do business.
  • "Corporation" is a business which is incorporated in the state of Nevada or in any other state, and which is recognized as an active corporation by the Secretary of State for the State of Nevada.
  • A"Type of Business" means the nature of business . . .
  • "Individual" is a person who operates a business which hires no employees, subcontractors or independent contractors.
  • "Partnership" is a business which is owned and operated by two or more individuals who share ownership rights to the net profits of the business and who share in all the liabilities of that business. A limited partnership is included in the term partnership if the limited partners are investors only, and do not perform services for the business.
  • "Principal Owner" is the owner, sole operator, designated general partner, or resident agent for the corporation.
  • "Sole proprietor" is a self-employed owner of an unincorporated business and includes working partners and members of working associations which may or may not hire employees.
D-25(2) (rev. 3/01)
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What an Affirmation of Compliance Is

An Affirmation of Compliance is a signed declaration by an individual or organization certifying that specified activities, records, products, or processes meet stated laws, regulations, standards, or contractual requirements. The document typically identifies the parties, scope of the representation, applicable rules or standards, effective date, and an explicit attestation of compliance. It can be used to support audits, vendor onboarding, contract closeouts, internal control documentation, or regulatory reporting. When required, the affirmation may be notarized or accompanied by supporting evidence and retained as an auditable record.

Why an Affirmation of Compliance Matters

An Affirmation of Compliance creates a clear, signed record that a party asserts conformity with legal, regulatory, or contractual obligations. It reduces ambiguity, supports audit trails, helps demonstrate due diligence, and aligns responsibilities among stakeholders while providing a durable document for internal or external review.

Why an Affirmation of Compliance Matters

Who Typically Prepares and Signs This Document

Typical users include internal compliance teams, third-party vendors, procurement officers, and regulatory reviewers who need a concise compliance declaration.

  • Compliance officers maintaining audit-ready records, tracking remediation, and coordinating regulatory responses across the organization.
  • Vendors and contractors certifying adherence to contractual obligations, security controls, and technical or industry-specific standards.
  • Procurement, legal, and risk teams documenting supplier obligations during onboarding, renewals, or contract closeout processes.

Core Elements to Include in a Professional Affirmation of Compliance

A well-constructed Affirmation of Compliance combines defined scope, authoritative signatories, dated attestations, and supporting evidence to ensure legal clarity and auditability.

Parties

List full legal names, physical addresses, and contact information for declarants and recipients; for organizations include authorized representative name and job title to avoid ambiguity.

Scope

Specify the exact systems, processes, contract sections, or time periods covered by the affirmation and note any exclusions to prevent misinterpretation during review.

Attestation

Use direct, unambiguous language stating that the subject matter complies with identified standards, statutes, or contractual clauses; avoid conditional phrasing unless required.

Effective Date

Provide the effective date and, if different, the covered period. The effective date determines the timeframe for obligations, audits, and potential liability.

Supporting Evidence

Reference or attach relevant documentation such as test reports, certificates, audit logs, remediation records, or policy excerpts that substantiate the compliance claim.

Signatures

Include signer name, title, date, and execution method (electronic, handwritten, notarized); indicate authority for organizational signers to strengthen enforceability.

Step-by-Step: Completing an Affirmation of Compliance

Follow these sequential steps to prepare, review, execute, and archive an Affirmation of Compliance that stands up to audit scrutiny.

  • 01
    Prepare: Gather scope, references, and supporting documents.
  • 02
    Draft: Write clear attestations and list signatory authority.
  • 03
    Sign: Obtain required signatures, notarization, or eSign authentication.
  • 04
    Archive: Store the signed file and audit trail in retention system.

Recommended Online Workflow Settings

Configure workflow settings to balance signer convenience with authentication and recordkeeping requirements.

Field Configuration
Authentication Method Email link, SMS code, KBA, or SSO per policy
Signature Type Choose electronic signature or RON notarization where required
Retention Policy Automatic export to secure storage per retention schedule
Notification Settings Reminders and completion alerts to stakeholders

Platform Capabilities to Support Electronic Affirmations

Digital execution requires secure signing, reliable signer authentication, and exportable audit trails to preserve evidentiary value.

  • Authentication: Email, SMS, KBA, or SSO options
  • Audit Trail: Timestamps, IP, and action logs
  • Format Support: Signed PDF and exportable XML

Typical Electronic Submission Flow

The electronic signing process follows a predictable sequence: upload, prepare fields, authenticate signers, capture signatures, and archive signed records with an audit trail.

  • Upload Document: Sender uploads the affirmation template
  • Place Fields: Add signature, date, and optional conditional fields
  • Authenticate: Signer receives link and authenticates per policy
  • Complete: Signature captured; signed copy and audit trail saved

Timing Considerations and Typical Deadlines

Affirmations of Compliance often follow project milestones, contract renewals, audit cycles, or regulatory reporting deadlines; plan execution and retention accordingly.

Pre-Project:

Obtain affirmation before work or data transfers begin

Contract Renewal:

Reaffirm compliance at renewal or material change

Audit Response:

Provide signed affirmation within auditor or regulator timeframe

Regulatory Filing:

Align affirmation timing to coincide with required filings

Retention Trigger:

Retain according to document lifecycle rules after execution

Key Penalties and Risks of Incorrect Affidavits

False Statement: Civil or criminal liability
Contract Breach: Damages or termination risk
Regulatory Sanctions: Fines or corrective orders
I-9 Violations: Penalties under DHS guidance
Tax Exposure: Backup withholding or penalties
Loss of Funding: Grant or contract repayment risk

Common Mistakes to Avoid When Preparing an Affirmation

  • Using vague or overly broad scope language that leaves the affirmation open to differing interpretations during audits or disputes.
  • Failing to attach or reference supporting evidence, which weakens the probative value of the attestation for regulators or auditors.
  • Allowing unauthorized staff to sign; always confirm corporate authority for organizational attestations to avoid invalidation.
  • Neglecting to record the signature method and authentication steps, reducing the document's value in e-discovery or legal challenges.

eSignature Platform Comparison for Executing an Affirmation of Compliance

Platform choice affects authentication, audit trails, HIPAA support, and cost. The table compares signNow against commonly used alternatives by core criteria.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day trial Varies by vendor Varies by vendor Varies by vendor Varies by vendor
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Security, Privacy, and Compliance Features to Check

Encryption: TLS 1.2/1.3 in transit; AES-256 at rest
HIPAA: BAA available for protected health information
21 CFR Part 11: Support for FDA-regulated record requirements
Certifications: SOC 2 Type II and ISO 27001
Privacy: GDPR and CCPA compliance features
Accessibility: WCAG 2.0 Level AA support

Real-World Examples of Affirmations in Use

These brief examples show how organizations use an Affirmation of Compliance to document controls, speed approvals, and support audits.

Optica Ventures LLC

Optica used an affirmation during vendor onboarding to document cybersecurity controls.

  • Streamlined third-party verification.
  • Brian Fitzgibbons, COO: "The interface is simple and easy-to-use for our team; more importantly, it is just as easy for our customers." This clarity reduced back-and-forth and shortened onboarding timelines.

Martin Properties

A real estate operator used affirmations to confirm contractor compliance with safety protocols.

  • Reduced site delays.
  • Tim Martin, Founder: "I can process and execute all of these documents online with 100% compliance and built-in security. Whether on mobile or working offline, I can get forms back to their necessary parties efficiently." The signed attestations supported timely project milestones.

Frequently Asked Questions and Troubleshooting

Answers to common questions about validity, signatures, notarization, and digital execution of an Affirmation of Compliance.


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