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Contractor Registration Application

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  2. The legal business name is the name that will appear on the license and is the actual name under which the contracting business will operate. The full business name must be provided.

  3. Indicate the appropriate classification of this application.

  4. Application Year:*

    Registration is done on a yearly basis and all licenses expire on April 30th, regardless of issue date. If you begin work in the previous year, you must renew your application for the following year. Indicate the yearly license this application coincides with.

  5. Check the Appropriate Classification: *

  6. Please list the area of specialty or a brief description of the type of work the applying company performs.

  7. A contact individual is required for every classification on every license issued by the Village of Elwood. You must provide full legal names of all individuals and qualifiers.

  8. Where applicable, the following must be completed by all individuals who will be listed on the license. You must provide full legal names of all indivuals.

  9. All questions must be answered. If you checked 'yes' in response to any of these questions, the person involved must attach a separate sheet with a detailed explanation for each situation.

  10. To the best of your knowledge, is anyone listed on this application (or any company the person is or was a part of), named in or responsible for any entered and unsatisfied judgments, liens, and/or claims against any bond or cash deposit pertaining to a construction project? If you checked “Yes” for this question, you are required to attach a statement identifying all judgments (pending or on record), liens, past due unpaid bills, claims, or suits and a detailed explanation of the situation. Include the names and addresses of the parties involved. If the obligation was or is being discharged in bankruptcy, attach a copy of the bankruptcy filing and a copy of the creditors list.*

  11. Has any individual listed on this application ever been convicted of or plead guilty to ANY misdemeanor or felony in the United States or a foreign country? If you checked “Yes” for this question, you are required to attach a statement disclosing all pleas/convictions, including violated law sections, and thoroughly explain the acts or circumstances which resulted in the plea/conviction.*

  12. To the best of your knowledge, has anyone on this application (or any company the person was a part of) ever received a citation from the Contractors State License Board or had a contractor license or registration denied, suspended, or revoked by this state or elsewhere? (Check “No” if the license was suspended due to lack of a bond, workers’ compensation insurance, a qualifying individual, or family support.) If you checked “Yes” for this question, you are required to attach a statement detailing the events leading to this action.*

  13. Check with your insurance carrier to ensure you are properly covered.

  14. Bond Requirements*

    Prior to the commencement of construction or commencement of any services within the Village of Elwood, each contractor/sub-contractor shall secure a standard license and/or permit indemnity/surety bond in favor of the Village of Elwood in the amount of $10,000. Said bond shall remain in effect for the period of construction or completion of all services by said contractor or sub-contractor, and shall only be released upon written authorization by the Village of Elwood. Therefore, a bond only needs to be issued when a job is scheduled.

  15. The Village of Elwood must be listed as a Certificate Holder and issued a valid Certificate of Liability Insurance.*

    Commercial General Liability covering the insured against claims of bodily injury, personal injury and property damage (including loss of use thereof) arising out of Seller/Contractor's operations, actions and contractual liabilities including a Broad Form Endorsement covering the insurance provisions of this Agreement, for limits of liability no less than:

  16. All Risk Property Insurance covering all materials, fixtures and personal property of owner in connection with any work conducted by contractor or subcontractor. Such insurance must be written on an "All Risks" of physical loss or damage basis, for the full replacement cost value and shall include coverage for damage or other loss caused by fire or other peril including, but not limited to, vandalism and malicious mischief, theft, water damage of any type, including sprinkler leakage, bursting or stoppage of pipes, and explosion.

  17. Workers' Compensation and Employer's Liability, in an amount no less than $1,000,000, or other similar insurance pursuant to all applicable state and local statutes and regulations, whichever is greater.

  18. Double check your form and attachments.

  19. Indicate Payment Method:*

    Contractor Registration requires a payment of the current registration fee in the amount of $100. Please see the 'Information' section below for details on where to submit payment.

  20. Please submit any additional information, attachments or payment by phone to (815) 423-5011, by fax to (815) 423-6818, by email to syreeta.slappey@villageofelwood.com or by mail to Village of Elwood, 401 East Mississippi Avenue, Elwood, IL 60421.

  21. Before submitting the application, ensure the necessary information has been included and all requirements have been met: *

  22. Please attach the Certificate of Liability naming the Village of Elwood as a Certificate Holder.

  23. IF REQUIRED: Please attach the Bond Requirements. Mail the original copy to address listed in the 'Information' section.

  24. IF REQUIRED: Please attach any supporting documents that are necessary to complete the application.

  25. Read through the application thoroughly and understand the Village of Elwood ordinances and permit requirements.

  26. In consideration of this application and attached forms being made a part thereof, the applicant will conform to the regulations set forth in the Village of Elwood codes and ordinances. The applicant's signature below indicates the information contained in this application and on any accompanying documents is true and correct. This is to certify, I am authorized to renew/apply for this license on behalf of any other owner(s) of the licensed entity and that all owners/officers/partners/members/qualifying agents are aware of the following: -All information and attachments, including financial statement(s) for the licensed entity is true and correct. -The Village of Elwood may refuse to renew a license for lack of insurance. I do hereby state under oath that I will not violate any of the Village of Elwood ordinances in the conduct of my/our business. Furthermore, I state that I understand the Village of Elwood's building codes, inspection requirements and conduct of business regulations.

  27. By providing this Electronic Signature Acknowledgment Form, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.

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  29. This field is not part of the form submission.