Fillable 2020 Contractor Registration Packet (Village of Ashville)

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2020 Contractor Registration Packet (Village of Ashville)

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Village of Ashville
P.O. Box 195
200 East Station Street
Ashville, OH 43103
Office: 740/983-6367 Ext. 1 • Fax: 740/983-4703
Email: atrimmer@ashvilleohio.gov
Building Department
CONTRACTOR/SUBCONTRACTOR REGISTRATION
If you desire to operate as a contractor/subcontractor in the Village of Ashville, you are required to
submit the enclosed APPLICATION FOR CONTRACTOR/SUB-CONTRACTOR REGISTRATION
accompanied by the required documents and fee(s) ANNUALLY.
Requirements to obtain a “Contractor/Sub-Contractor Registration” are as follows:
The fee required to accompany the application is seventy-five dollars ($75.00) PER trade
made payable to the Village of Ashville.
Evidence of a current license issued by the Ohio Construction Industry Examining Board
(OCIEB) is required for registration as Plumbing, Electrical, HVAC, Refrigeration, and
Hydronics contractors, Ohio Revised Code Chapter 4740.
Evidence of a current license issued by the Ohio State Department of Health is required for
registration as asbestos, lead or radon abatement and/or testing contractors.
Certificate of Insurance indicating the General Liability coverage limits with a 10-day
cancellation notice. General Liability insurance, including but without limitation, for bodily injury
in the amount of one hundred thousand dollars/three hundred thousand dollars
($100,000/$300,000), and for property damage in the amount of at least fifty thousand dollars
($50,000) or such greater amounts as permitted by Ohio R.C. 4740.06(B)(4).
Proof of current State of Ohio automobile coverage for the contractor’s vehicle(s) for the
period the contractor is registered to work in the Village, Ordinance No. 2007-09.
Copy of valid Ohio driver’s license.
Completed bond form with seal and attached power of attorney for EACH trade. The amount
of the Registration Bond is ten thousand dollars ($10,000.00) under Ordinance 1321.
Income tax registration with RITA (Form 48) (unless currently registered).
Self addressed stamped envelope (not necessary if registering in person).
* The penalty for starting work prior to obtaining a “Contractor/Sub-Contractor Registration” is one
hundred dollars ($100.00).
For your convenience the Building Department has attached the following:
An APPLICATION FOR CERTIFICATE OF CONTRACTOR/SUBCONTRACTOR
REGISTRATION (you must list up to three agents who are able to pull permits under your
company’s name.)
A Village of Ashville REGISTRATION BOND form.
INCOME TAX REGISTRATION (if not previously registered with the Village of Ashville)
The enclosed documents contain specific information and instructions. Please read each form
completely and carefully.
Village of Ashville
P.O. Box 195
200 East Station Street
Ashville, OH 43103
Office: 740/983-6367 Ext. 1 • Fax: 740/983-4703
Email: atrimmer@ashvilleohio.gov
Building Department
CONTRACTOR / SUB-CONTRACTOR REGISTRATION
For Internal Use
Date:
/
___
___
/
___
Registration #
Registration #
Registration #
Registration #
Applicant Name:
Address:
Number & Street City/Village State Zip Code
Phone: Cell Phone
Company Name (DBA):
Address:
Number & Street City/Village State Zip Code
Phone: Cell Phone: Fax:
Email Address:
Federal ID # State Corporation #
Valid Driver’s License Number of applicant: Submit a copy with this application.
Check the trade for which the application is being made:
{ } General Building { } Electrical { } HVAC (Hydronic)
{ } Fire Suppression Commercial { } Plumbing { } Other (describe below)
Contractors MUST provide a copy of their State License in order to obtain Electrical, Plumbing and/or HVAC Registrations
for Commercial Permits
Authorized Agents
All registrations Expire on December 31
st
of each year.
I hereby indicate that all of the information is true to the best of my knowledge, that I am at least 18 years of
age, able to interpret construction plans and specifications, and able to comply with the requirements of the
Village of Ashville Ordinances/Resolutions.
Print Applicant’s Name Signature of Applicant
Approved _____ Disapproved_____
Date: Signature of Building Inspector
Village of Ashville
P.O. Box 195
200 East Station Street Ashville, OH 43103
Office: 740/983-6367 Ext. 1 • Fax: 740/983-4703
Email: atrimmer@ashvilleohio.gov
BOND NO.
(REQUIRED)
Ashville, Ohio
REGISTRATION BOND
KNOW ALL MEN BY THESE PRESENTS, THAT WE, _________________________
doing business as principal, hereinafter referred to as the principal, and, _________________
as surety, hereinafter referred to as the surety, are held and firmly bound unto the Village of Ashville, in the
sum of Ten Thousand Dollars ($10,000) for payment of which, well and truly to be made we bind ourselves,
our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.
Witness our hand and seals this _____ day of ________________ , 20____.
The conditions of the above obligations are such that:
Whereas, the said principal made application to the Village of Ashville for a license/registration in
accordance with Ordinance 2010-02 of the Village of Ashville Chapter 1321.03Codified Ordinances, as a
contractor to engage in the business of:
_____General Building _____ HVAC (Hydronics)
_____Plumbing _____Electrical
_____Fire Suppression commercial _____Other, provide details on line below
within the Village of Ashville during the calendar year of in accordance with the provisions of Code of
Ordinances of the Village of Ashville.
Now therefore, if the said principal shall faithfully observe all the duties and discharge all the obligations incurred by him during
said registration period under the ordinances of the Village of Ashville applying to the construction, alterations, repair, addition
to, subtraction from, reconstruction or remodeling of any building, structure or appurtenance thereto, or any part thereof, and the
ordinances applying to underground construction and/or work within the public right of way, and all the lawful orders of the
Village of Ashville, issued under said ordinances, then this obligation shall be void, otherwise, the same shall be and remain in
full force and effect; the undersigned agreeing and consenting that this undertaking shall be for the benefit of any party damaged
by the principal’s failure to comply with the duties, terms, conditions, provisions and requirements of the ordinances of the
Village of Ashville applying to such work and the lawful orders of the Village of Ashville issued under such ordinances, as
well as for the benefit of the obligee herein, and either or both may bring action on the bond, but said action must be commenced
within two years after expiration of the principal’s registration.
SEAL
PRINCIPAL
SURETY
(SIGNATURE OF AGENT EXECUTING BOND)
NOTE: ATTACH POWER OF ATTORNEY
(If this Bond is executed by any agent for a Principal or a Surety, such Agent must affix a copy of his Power of Attorney or other
evidence of authority to execute the Bond. If the Surety is a non-resident corporation of the State of Ohio, its authority to do
business in Ohio must, likewise, be attached hereto).
Business Type Reason for Registration
Corporation
Non-Profit
Courtesy withholding for an employee's resident municipality
S-Corp Estate & Trust Doing business within the municipality this year (temporary)
LLC
Sole Proprietor / LLC Approx. # of days Start Date
Partnership
Business with a fixed location
Company Information
(List physical address of work performed within this municipality)
Name: Federal ID #:
Address:
SSN :
City/State/Zip:
Mailing Address
(for withholding tax forms / if different from above)
Mailing Address
(for net profit tax forms / if different from above)
Filing Status:
Calendar year Fiscal year / month ending
Do you have any employees? Yes No
Number of employees at RITA location
My withholding is filed under a 3rd party account (PEO or common paymaster)
Monthly gross payroll at RITA location $
I am a small employer (under $500,000 in gross revenue during previous year)
Contractors
I am a contractor Yes No
Will you be using sub-contractors?
Total contract amount of the project $
The Information Hereby Submitted is True and Correct.
Phone Number
/ /
*Please note that your Federal Identification Number will serve as your RITA account number.
Municipality
Date business began at this location
(required if sole proprietor)
Yes
No
If yes, list Federal ID #
Yes
No
Yes
No
If yes, complete page 2.
Print Name
Title
Date
Please complete and sign this Registration Form and return within 10 business days. Please be advised that failure to timely register with RITA may result in delays in the
processing of any required income tax filings or may result in future penalty and interest charges, if applicable. If you have any questions please contact the Registration
Department at the number below.
Signature
ritaohio.com
Call: 800.860.7482, ext. 5008
TDD: 440.526.5332
Fax: 440.526.3136
Mail to: RITA
ATTN: BUSINESS REGISTRATION
P.O. BOX 477900
BROADVIEW HEIGHTS, OH 44147-7900
FORM
48
Regional Income Tax Agency
Business Registration Form
PRINT FORM
RESET FORM
$
$
$
$
$
EIN or Social Security #
Trade
Sub-contractor Name / Address
Contact Name
Contract Amount
Phone Number
Estimated Start Date
EIN or Social Security #
Trade
Sub-contractor Name / Address
Contact Name
Contract Amount
Phone Number
Estimated Start Date
EIN or Social Security #
Trade
Sub-contractor Name / Address
Contact Name
Contract Amount
Phone Number
Estimated Start Date
EIN or Social Security #
Trade
Sub-contractor Name / Address
Contact Name
Contract Amount
Phone Number
Estimated Start Date
EIN or Social Security #
Trade
Sub-contractor Name / Address
Contact Name
Contract Amount
Phone Number
Estimated Start Date
Sub-contractor Name / Address
$
Contact Name
Contract Amount
Phone Number
Estimated Start Date
EIN or Social Security #
Trade
*If more space is needed, you may attach a separate schedule that includes ALL of the required information listed above.
Mail to: RITA
ATTN: BUSINESS REGISTRATION
P.O. BOX 477900
BROADVIEW HEIGHTS, OH 44147-7900
Call: 800.860.7482, ext. 5008
TDD: 440.526.5332
Fax: 440.526.3136
ritaohio.com
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2020 Contractor Registration Packet (Village of Ashville)

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Completed 14 July 2020

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