Fillable ARIZONA REGISTRAR OF CONTRACTORS (LIMITED LIABILITY COMPANY) (Arizona)

Fill Online, Printable, Fillable, Blank ARIZONA REGISTRAR OF CONTRACTORS (LIMITED LIABILITY COMPANY) (Arizona) Form

Use Fill to complete blank online ARIZONA pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

ARIZONA REGISTRAR OF CONTRACTORS (LIMITED LIABILITY COMPANY) (Arizona)

On average this form takes 46 minutes to complete

The ARIZONA REGISTRAR OF CONTRACTORS (LIMITED LIABILITY COMPANY) (Arizona) form is 16 pages long and contains:

  • 7 signatures
  • 36 check-boxes
  • 141 other fields

Country of origin: US
File type: PDF

BROWSE ARIZONA FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
ARIZONA REGISTRAR OF CONTRACTORS
Douglas A. Ducey, Governor
Jeff Fleetham
,
Director
1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ● www.roc.az.gov
License Application (LLC)
Form RC-L-200B
Instructions
L
ICENSE
A
PPLICATION
(LIMITED LIABILITY COMPANY)
THIS APPLICATION IS FOR LLCS ONLY
This License Application is for an LLC seeking to obtain an Arizona Contractor’s License.
If the Applicant is a sole-proprietorship, use the Sole-Proprietorship License Application Form.
If the Applicant is a corporation that is not owned or operated by another entity, use the
Corporation
License Application Form.
If the Applicant is a partnership that is not owned or operated by another entity, use the
Partnership
License Application Form.
If the Applicant is a tiered entity, you must contact the Registrar’s Licensing Department at (602) 542-
1525 for assistance. A Tiered Entity is an entity that is owned or operated by another entity.
• For example, if “Red Corporation” is owned or operated by “Blue, LLC,” “Red Corporation”
would be considered a Tiered Entity for the purposes of obtaining a contractor’s license.
STEPS TO OBTAIN A CONTRACTOR’S LICENSE
To obtain an Arizona Contractor’s License, complete the following:
1) Identify a Qualifying Party: The Applicant must identify a Qualifying Party for the license. A
Qualifying Party is a regularly employed person with the necessary experience, knowledge and
skills as defined under A.R.S. § 32-1122(E).
2) Pass Examination(s). The Qualifying Party must pass the required exams by at least 70% and
submit exam results.
The Qualifying Party must complete a business management exam (BME)
and a specific trade exam, unless eligible for a waiver.
• To determine which exams are required for a specific license classification, refer to the
Registrar’s License Classification Requirements
.
• The Qualifying Party can register to take an exam through PSI Exams Online.
• For information about PSI’s testing procedures, refer to
PSI's Candidate Information
Bulletin.
3) Submit to Background Checks. The Qualifying Party listed in Part 2, and each individual
listed in Part 3: Persons in this License Application Form must submit copies of the payment
transaction receipt from their background checks.
4) Form a Legal Entity. Form or register an LLC with the Arizona Corporation Commission.
5) Complete and Submit Project Verification Forms. The Qualifying Party must complete
the correct number of Project Verification Forms
, and
a verifier must sign each Project
Verification Form. The Project Verification Forms must be submitted with this License
Application Form.
(continued on next page)
ARIZONA REGISTRAR OF CONTRACTORS
Douglas A. Ducey, Governor
Jeff Fleetham
,
Director
1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ● www.roc.az.gov
License Application (LLC)
Form RC-L-200B
Instructions
6) Complete and Submit Experience Verification Forms. The Qualifying Party must
complete the correct number of Experience Verification Forms, and a verifier must sign each
Experience Verification Form. The
Experience Verification Forms must be submitted with this
License Application Form.
7) Bond. The Applicant must obtain and submit proof of a license Bond.
8) Pay the Fees. Include the required fees and assessments with your License Application form.
9) Government-Issued Identification. The Qualifying Party listed in Part 2, and each individual
listed in Part 3: Persons in this License Application Form
must submit a copy of their
government issued identification with the application.
10) Complete and Submit This Application. Complete and submit this License Application
Form to the Registrar using one of the following methods:
Mail this application to:
Registrar of Contractors
P.O. Box 6748
Phoenix, AZ 85005-6748
Deliver this application to:
Registrar of Contractors
1700 W. Washington Street, Suite 105
Phoenix, AZ 85007-2812
WAIVERS
Some of the requirements listed below may be waived depending on an Applicant’s past experience in
the contracting field. To determine if a waiver applies to your application, refer to the Registrar’s online
Waiver Eligibility page.
AGENCY DISCLOSURE
Pursuant to A.R.S. § 41-1030(G), the Registrar provides the following disclosures:
• A.R.S. § 41-1030(B): An agency shall not base a licensing decision in whole or in part on a
licensing requirement or condition that is not specifically authorized by statute, rule or state
tribal gaming compact. A general grant of authority in statute does not constitute a basis for
imposing a licensing requirement or condition unless a rule is made pursuant to that general
grant of authority that specifically authorizes the requirement or condition.
• A.R.S. § 41-1030(D): This section may be enforced in a private civil action and relief may be
awarded against the state. The court may award reasonable attorney fees, damages and all fees
associated with the license application to a party that prevails in an action against the state for a
violation of this section.
• A.R.S. § 41-1030(E): A state employee may not intentionally or knowingly violate this section.
A violation of this section is cause for disciplinary action or dismissal pursuant to the agency's
adopted personnel policy.
• A.R.S. § 41-1030(F): This section does not abrogate the immunity provided by § 12-820.01 or
12-820.02.
***DO NOT SUBMIT THESE INSTRUCTIONS WITH YOUR APPLICATION***
1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ● www.roc.az.gov
License Application (LLC)
Form RC-L-200B Page 1 of 8
Form
RC-L-200B
LICENSE APPLICATION
(LLC)
For Internal Use Only
Pending #______________
PART 1: APPLICANT INFORMATION
• An Authorized Representative is a person with the authority to sign on behalf of the LLC.
• The business address you provide will be publicly available on the Registrar’s website.
o To obtain a contractor’s license, an applicant must provide their mailing address and the address
address. A.R.S. §§ 32-1122(B)(1)(b) & (f).
• To determine the appropriate License Classification Description in box 6, refer to the Registrar’s License
Classifications located at https://roc.az.gov/license-classifications.
1. Limited Liability Company Name
2. Fictitious Trade Name (i.e. DBA), if applicable.
Warning: A licensee must do business under the name on the license issued. See A.A.C. R4-9-109(A). If you are
using a fictitious trade name (i.e. DBA), then the name of the LLC and the fictitious trade name must be included in
all contracts and advertisements.
3. Authorized Representative’s Name as it Appears on a Government-Issued ID
4. Authorized Representative’s Date of Birth (MM/DD/YYYY)
5. Authorized Representative’s Social Security Number
6. Requested License Classification Description
7. Federal Employer Identification Number (EIN)
8. Business Address (No PO Boxes or Private Mail Boxes)
City
State
Zip Code
9. Mailing Address (If different than business address)
City
State
Zip Code
10. Phone Number
11. Email Address
CONSENT
Email / Telephone
12. I consent to receive notifications from the Registrar by email at the following
email address
.....................................................................................................................................................................
13. I consent to receive notifications from the Registrar by text messaging at the
following telephone number
..................................................................................................................................
1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ● www.roc.az.gov
License Application (LLC)
Form RC-L-200B Page 2 of 8
PART 2: QUALIFYING PARTY
QUALIFYING PARTY
The "Qualifying Party" is a person who is regularly employed by the Applicant and is actively engaged in the
classification of work for which the person qualifies on behalf of the Applicant.
• The Qualifying Party must have the necessary experience, knowledge and skills to supervise or perform the
contracting work.
1. Name as it appears on your government issued ID 2. Title/Position
3. Ownership %
4. Date of Birth (MM/DD/YYYY)
5. Driver’s License or Government ID No.
6. Social Security Number
7. Residential Address City State
Zip Code
8. Mailing Address (If different than residential address)
City State Zip Code
9. Phone Number
10. Email Address
CONSENT
Email / Telephone
11. I consent to receive notifications from the Registrar by email at the following
email address
.....................................................................................................................................................................
12. I consent to receive notifications from the Registrar by text messaging at the
following telephone number
..................................................................................................................................
“Notifications” include renewal notices and monthly newsletters. By consenting to receive notifications via text or email, you
will not be excluded from receiving notifications by regular mail. You consent by entering the information above.
1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ● www.roc.az.gov
License Application (LLC)
Form RC-L-200B Page 3 of 8
PART 3: PERSONS
C
OMPLETE AND ATTACH ADDITIONAL
P
ART
3
S AS NECESSARY TO PROVIDE THE INFORMATION
FOR ALL OF THE FOLLOWING PERSONS ON THE LICENSE.
• Owners of 25% or more of the stock or beneficial interest of the LLC.
• If the Applicant is a Member-Managed LLC, then complete Part 3 for each Member.
• If the Applicant is a Manager-Managed LLC, then complete Part 3 for each Manager.
This information is required under A.R.S. § 32-1122(B)(1)(d).
Every person listed on this application must be 18 years of age or older and must sign this application form
under Part 6: Signatures.
Arizona Corporation Commission Documents
To determine which individuals are members or managers of an LLC, refer to the LLC’s
entity documents. E
ntity documents can be located using the Corporation Commission’s
search tool located at http://ecorp.azcc.gov/Search.
• Note: This application is only for LLCs owned solely by individuals.
• If any corporation, LLC, partnership, trust, or other business organization is listed
on the applying entity’s Arizona Corporation Commission documents, then you
must contact the Registrar’s Licensing Department at (602) 542-
1525 for
assistance.
This application is for a:
Member-Managed LLC……………………………………………………………………………….
Manager-Managed LLC……………………………………………………………………………….
M
EMBER
/
M
ANAGER
The Registrar requires all of the information below for each member (if the applicant is a member-managed LLC) or each
manager (if the applicant is a manager-managed LLC).
1. Name as it appears on your government-Issued ID
2. Title/Position (“Member” or “Manager”) 3. Ownership %
4. Date of Birth (MM/DD/YYYY)
5. Identification No. (Driver’s License or Government ID No.)
6. Social Security Number
7. Business or Residential Address City State Zip Code
8. Mailing Address (If different than business or residential address) City State Zip Code
9. Phone Number 10. Email Address
CONSENT
Email / Telephone
11. I consent to receive email notifications from the Registrar at the following
email address
.....................................................................................................................................................................
12. I consent to receive text notifications from the Registrar at the following
number
...................................................................................................................................................................................
“Notifications” include renewal notices and monthly newsletters. By consenting to receive notifications via text or email, you
will not be excluded from receiving notifications by regular mail. You consent by entering the information above.
1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ● www.roc.az.gov
License Application (LLC)
Form RC-L-200B Page 4 of 8
M
EMBER
/
M
ANAGER
The Registrar requires all of the information below for each member (if the applicant is a member-managed LLC) or each
manager (if the applicant is a manager-managed LLC)
1. Name as it appears on your government-Issued ID
2. Title/Position (“Member” or “Manager”)
3. Ownership %
4. Date of Birth (MM/DD/YYYY)
5. Identification No. (Driver’s License or Government ID No.)
6. Social Security Number
7. Business or Residential Address
City
State
Zip Code
8. Mailing Address (If different than business or residential address)
City
State
Zip Code
9. Phone Number
10. Email Address
CONSENT
Email / Telephone
11. I consent to receive email notifications from the Registrar at the following email
address
...........................................................................................................................................................................................................
12. I consent to receive text notifications from the Registrar at the following number
.................
“Notifications” include renewal notices and monthly newsletters. By consenting to receive notifications via text or email, you
will not be excluded from receiving notifications by regular mail. You consent by entering the information above.
M
EMBER
/
M
ANAGER
The Registrar requires all of the information below for each member (if the applicant is a member-managed LLC) or each
manager (if the applicant is a manager-managed LLC).
1. Name as it appears on your government-Issued ID
2. Title/Position (“Member” or “Manager”)
3. Ownership %
4. Date of Birth (MM/DD/YYYY)
5. Identification No. (Driver’s License or Government ID No.)
6. Social Security Number
7. Business or Residential Address
City
State
Zip Code
8. Mailing Address (If different than business or residential address)
City
State
Zip Code
9. Phone Number
10. Email Address
CONSENT
Email / Telephone
11. I consent to receive email notifications from the Registrar at the following email
address
...........................................................................................................................................................................................................
12. I consent to receive text notifications from the Registrar at the following number
.................
“Notifications” include renewal notices and monthly newsletters. By consenting to receive notifications via text or email, you
will not be excluded from receiving notifications by regular mail. You consent by entering the information above.
1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ● www.roc.az.gov
License Application (LLC)
Form RC-L-200B Page 5 of 8
M
EMBER
/
M
ANAGER
The Registrar requires all of the information below for each member (if the applicant is a member-managed LLC) or each
manager (if the applicant is a manager-managed LLC)
1. Name as it appears on your government-Issued ID
2. Title/Position (“Member” or “Manager”)
3. Ownership %
4. Date of Birth (MM/DD/YYYY)
5. Identification No. (Driver’s License or Government ID No.)
6. Social Security Number
7. Business or Residential Address
City
State
Zip Code
8. Mailing Address (If different than business or residential address)
City
State
Zip Code
9. Phone Number
10. Email Address
C
ONSENT
Email / Telephone
11. I consent to receive email notifications from the Registrar at the following email
address
...........................................................................................................................................................................................................
12. I consent to receive text notifications from the Registrar at the following number
.................
“Notifications” include renewal notices and monthly newsletters. By consenting to receive notifications via text or email, you
will not be excluded from receiving notifications by regular mail. You consent by entering the information above.
M
EMBER
/
M
ANAGER
The Registrar requires all of the information below for each member (if the applicant is a member-managed LLC) or each
manager (if the applicant is a manager-managed LLC)
1. Name as it appears on your government-Issued ID
2. Title/Position (“Member” or “Manager”)
3. Ownership %
4. Date of Birth (MM/DD/YYYY)
5. Identification No. (Driver’s License or Government ID No.)
6. Social Security Number
7. Business or Residential Address
City
State
Zip Code
8. Mailing Address (If different than business or residential address)
City
State
Zip Code
9. Phone Number
10. Email Address
C
ONSENT
Email / Telephone
11. I consent to receive email notifications from the Registrar at the following email
address
...........................................................................................................................................................................................................
12. I consent to receive text notifications from the Registrar at the following number
.................
“Notifications” include renewal notices and monthly newsletters. By consenting to receive notifications via text or email, you
will not be excluded from receiving notifications by regular mail. You consent by entering the information above.
1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ● www.roc.az.gov
License Application (LLC)
Form RC-L-200B Page 6 of 8
PART 4: DISCLOSURES
W
ORKERS
’
C
OMPENSATION
C
OMPLIANCE
Under A.R.S. § 32-
1122(B), to obtain or renew a license, an applicant must demonstrate
compliance with the statutes or rules governing workers’ compensation insurance. Failure to
comply with these statutes or rules is a violation of A.R.S. § 32-1154(A)(4). Possible methods
of compliance include:
• Insurance Carrier:
Obtaining Workers’ Compensation with an insurance carrier
authorized by the Director of Insurance to write workers’ compensation insurance in
this state; or
• Self-Insured: Obtaining a “Resolution of Authorization” from the Industrial
Commission of Arizona to act as a self-
insurer for payment of Workers’
Compensation benefits to employees; or
• Exemption:
Being exempt from the statutes or rules governing Workers’
Compensation by being self-employed and not employing workers.
Circle One
1. The Applicant is in compliance with the statutes or rules governing Workers’
Compensation insurance.
(Yes) (No)
P
RIOR
L
ICENSE
I
NFORMATION
If ‘yes’ is selected for questions 2-3, that person must complete and attach a Prior License
Disclosure Form with this application.
Circle One
2. Has the Qualifying Party listed in Part 2 ever been named on a license in any state?
(Yes) (No)
3. Has any individual listed in Part 3: Persons of this application ever been named on a
license in any state?
(Yes) (No)
FELONY CHARGES
If ‘yes’ is selected for questions 4-7, that person must complete and attach the Felony
Disclosure Form with this application. Answering ‘yes’ does
not automatically disqualify the
Applicant from receiving a contractor’s license. Circle One
4. Has the Qualifying Party listed in Part 2 ever been convicted of a felony?
(Yes) (No)
5. Does the Qualifying Party listed in Part 2 have a felony charge pending?
(Yes) (No)
6. Has any individual listed in Part 3: Persons of this application ever been convicted of
a felony?
(Yes) (No)
7. Does any individual listed in Part 3: Persons of this application have a felony charge
pending?
(Yes) (No)
U
NLICENSED
A
CTIVITY
If ‘yes’ is selected for questions 8-9, that person must complete and attach the Unlicensed
Activity Disclosure Form with this application. Circle One
8. Has the Qualifying Party listed in Part 2 ever received a citation for, or been
convicted of, contracting without a license in any state?
(Yes) (No)
9. Has any individual listed in Part 3: Persons of this application ever received a citation
for, or been convicted of, contracting without a license in any state?
(Yes) (No)
1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ● www.roc.az.gov
License Application (LLC)
Form RC-L-200B Page 7 of 8
PART 5: REQUIRED DOCUMENTS
Before you submit your application, please review the following checklist.
Missing documents will delay the processing of your application.
Review the License Application and ensure that it contains the following:
Exam Results. The Qualifying Party’s original exam results, or a Completed Waiver Form.
Background Checks. Copies of the payment transaction receipt from the background check for
every individual named in Part 3: Persons and the Qualifying Party.
Papers for Legal Entity. A copy of the LLC agreement.
Project Verification Forms. Correct number of Project Verification Forms (completed by the
Qualifying Party and a verifier).
Experience Verification Forms. Correct number of Experience Verification Forms, (completed
by the Qualifying Party and a verifier).
Bond. Completed original Bond Verification Form.
Fees. The required application fee and licensing fee
Government-Issued Identification. The Qualifying Party listed in Part 2, and e
ach individual
listed in Part 3: Persons in this License Application must submit a
legible copy of a government
issued photo identification
with the application. Acceptable forms of identification include a valid
driver’s license or passport.
Signatures. Completed Signatures section (see next page).
SUPPLEMENTAL DOCUMENTS
Additional Part 3s: If there was insufficient space to enter all of the required information in Part
3 of this application, print out, complete, and attach additional Part 3s to your application.
Prior License Disclosure Forms. If ‘yes’ is selected for any of the Prior License Information
questions under Part 4, attach signed and completed Prior License Disclosure Form. Also include
forms and documentation of disciplinary resolution, if applicable.
License Cancellation Form.
If you currently have a license that you wish to cancel upon the
issuance of a new license, complete and attach a License Cancellation Form.
Felony Disclosure Forms. If ‘yes’ is selected for any of the Felony Charges questions under,
Part 4, attach signed and completed Felony Disclosure Forms and supporting documentation.
Unlicensed Activity Disclosure Forms. If ‘yes’ is selected for any of the Unlicensed Activity
questions under Part 4, attach signed and completed Unlicensed Activity Disclosure Forms and
documentation of remedial measures.
Letter Regarding Restricted License. To obtain a restricted license approval
an Applicant
must have prior written approval from the Registrar. The Applicant must submit the letter from
the Registrar approving a “restricted license,” if applying for a restricted license.
Solar Warranty.
A copy of the solar warranty (if applying for a solar license)
1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ● www.roc.az.gov
License Application (LLC)
Form RC-L-200B Page 8 of 8
PART 6: SIGNATURES
By signing below, each person certifies that the entire contents of this License Application
Form, including all supplementary statements and materials attached, are true and
correct, and that this application is not submitted with the intent to evade Chapter 10,
Title 32 of the Arizona Revised Statutes. A.R.S. § 32-1154(A)(9). It is a violation of A.R.S.
§ 32-1154(A)(5) to make a misrepresentation of a material fact in obtaining a license.
Applicant
The authorized representative listed in Part 1: Applicant Information must sign this application.
_____________________ _____________________
______________
Print Name Signature Date
Qualifying Party
The Qualifying Party listed under Part 2: Qualifying Party must sign this application.
_____________________ _____________________
______________
Print Name Signature Date
Persons
Every person listed under Part 3: Persons must sign this application. If you need additional space for
signatures, complete and attach additional signature pages with your application.
_____________________ _____________________ _____________________
Print Name Signature Date
_____________________ _____________________ _____________________
Print Name Signature Date
_____________________ _____________________ _____________________
Print Name Signature Date
_____________________ _____________________ _____________________
Print Name Signature Date
_____________________ _____________________ _____________________
Print Name Signature Date
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

ARIZONA REGISTRAR OF CONTRACTORS (LIMITED LIABILITY COMPANY) (Arizona)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 13 March 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document