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2. 
3. Contractor's License Application

   Once submitted someone from the Engineering Department will be in touch.

5. Type of Ownership

   Please supply the Town with a copy of your Certificate of Good Standing or if you are a Sole Proprietor or Partnership, please complete and return the attached Lawful Presence Affidavit. 

6. Certificate of Good Standing
8. Owner Name*
9. Address
11. Name of Business*
12. Phone*
13. E-Mail Address
15. Location of Business:
16. Business Street Address
18. Business City
19. Business State
20. Business Zip Code
22. Mailing Address:
23. Mailing Street Address
25. Mailing City
26. Mailing State
27. Mailing Zip Code
29. Please describe your main business?
31. Select the type of business:
    -- Select One --Class A (General)Class B1 (Electrical)Class B2 (HVAC)Class C (Irrigation/Roof/Siding/Drywall/Paver/Painter)Class D1 (Mason/Fence/Excavation)Class D2 (Signs/Glaziers)
32. # of Full Time Employees
33. # of Part Time Employees
35. Please attach a copy of your Certificate of Insurance

    Coverage: Public Liability $100,000 occurrence, $300,000 aggregate; Auto Liability $100,000 each person, $300,000 each accident; Workers Compensation – in accordance with State laws. 

37. Insurance Company
38. Name of Agent
39. Agent Phone

41. I declare under penalty of perjury in the second degree that the statements made in this questionnaire are true and complete to the best of my knowledge. 

43. Authorized Signature*
44. Date
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field