Name all Pennsylvania corporations, including all limited liability corporations, in which the applicant has any equity interest, regardless
of whether the applicant has a direct equity interest or applicant’s equity interest is held through one or more tiers of a corporate
structure, such as parent-subsidiary structure.
Declaration and Signature
I, the applicant, will comply with all laws, rules, and regulations of the Commonwealth. I hereby certify that the statements
contained herein are true and correct to the best
of my knowledge and belief. I understand that if I knowingly make any false statement herein I am subject to the possible revocation of any licenses issued as a result of
my false application, and such other penalties as may be prescribed by law or ordinance.
Applicant’s Signature: ___________________________________________________________________ Date: _______________________________
Applicant / Business
Information
Provide the contact
information for the
applicant
corporation (if
applicable).
account information.
Applicant Name: ____________________________________________________________________________________________
Applicant Address:___________________________________________________________________________________________
Applicant Email: ___________________________________________________ Phone #: _______________________________
Business/Company Name (if different from applicant): _______________________________________________________________
Business/Company Address: __________________________________________________________________________________
Business/Company Email: ___________________________________________ Phone #: _______________________________
Commercial Activity License #: _______________________ Philadelphia Business Income and Tax #: ________________________
PART B
Supplemental
Information
Insurance amounts:
o General Liability:
$500,000 per
occurrence
o Auto: $300,000
o Workman’s
compensation:
$100,000 per
accident
$100,000 per
employee
$500,000 policy
limit
NOTE: The City of
Philadelphia must be
named as the
certificate holder on an
ACCORD form.
Verify the following information:
An active certificate of insurance with the minimum insurance amounts is provided. ☐ Yes
All City of Philadelphia taxes, charges and fees are current. ☐ Yes
Safety Training Supervisor information responsible for construction projects
supervisor can only be employed by one company and must have completed an approved OSHA 30 Construction Safety and Health, or an
training course taken within five years of the application date.
Supervisor Name:____________________________________________________________________________________
Address: ___________________________________________________________________________________________
Email: ________________________________________________ Phone #:_________________________________
*OSHA 30 Card #:________________________________________ Effective Date: ____________________________
*Must provide a copy of your OSHA wallet card with this application.
Limits and
Conditions
• Contractors and subcontractors (including individuals and business entities) must have valid licenses. All subcontractors working
under a permit must be submitted to the Department.
Contractors cannot sell or transfer their license or permit to another person.
Contractors must provide accurate information on any license or permit application with the Department.
Contractors must get all required permits for construction work and comply with approved permit documents.
Contractors must maintain information at each job site as required by the Philadelphia Code.
Contractors must display their Contractor License number on any advertisements, stationery, places of business, job sites,
proposals, and vehicles displaying the business name.
Contractors must maintain complete financial and construction records (including plans) for each job performed for four years after
completion of the job.
Contractors must follow all provisions of The Philadelphia Code.
Application for Contractor License
Complete and submit this application for a NEW Contractor License.
Name of Pennsylvania Corporation
Home Address
(include City, State, Zip Code)
A
B
C
