Fillable CONSTRUCTION INDUSTRIES BOARD Initial/Renewal Application for Roofing Contractor (Oklahoma)

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CONSTRUCTION INDUSTRIES BOARD Initial/Renewal Application for Roofing Contractor (Oklahoma)

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Revised May 2018 1
CONSTRUCTION INDUSTRIES BOARD
2401 NW 23
rd
, Suite 2F
OKLAHOMA CITY, OK 73107
TELEPHONE: (405) 521-6550 TOLL FREE: 1-877-484-4424
Web site: http://www.cib.ok.gov
Initial/Renewal Application for Roofing Contractor Registration and, if applicable,
Commercial Endorsement
AMOUNT DUE FOR INITIAL ROOFING CONTRACTOR REGISTRATION:
$75.00
AMOUNT DUE FOR RENEWAL REGISTRATION:
$75.00
LATE FEE FOR RENEWAL OF A ROOFING REGISTRATION OVERDUE 31 TO 60 DAYS
AFTER BIRTH MONTH:
$100.00
LATE FEE FOR RENEWAL OF A SUSPENDED REGISTRATION OR REGISTRATION
OVERDUE MORE THAN 60 DAYS:
$150.00
REINSTATEMENT FEE FOR RENEWAL OF A REVOKED ROOFING REGISTRATION:
$300.00
AMOUNT DUE FOR INITIAL COMMERCIAL ENDORSEMENT (includes application fee):
$230.00
AMOUNT DUE FOR RENEWAL OF COMMERCIAL ENDORSEMENT:
$100.00
LATE FEE FOR COMMERCIAL ROOFING CONTRACTOR ENDORSEMENT RENEWAL
OVERDUE AFTER QUALIFYING PARTY'S BIRTH MONTH 31 DAYS TO 1 YEAR:
$100.00
ALL APPLICABLE FEES MUST ACCOMPANY APPLICATION:
Make remittance payable to the CONSTRUCTION INDUSTRIES BOARD (CIB)
===========================================================================
Instructions:
1. Return completed application with required registration fee and all applicable fees (endorsement fee, late fee(s),
reinstatement fee, etc.) to address listed above.
2. Provide the following information with the application:
a. Certificate of General Liability Insurance: Minimum $500,000.00 for Roofing Contractor Registration;
Minimum $1,000,000.00 for Roofing Contractor Registration and Commercial Endorsement
(REQUIRED: Construction Industries Board must be listed as a certificate holder and the policy must have
sufficient information to demonstrate that the policy specifically covers roofing work.)
b. Proof of securing workers’ compensation coverage or satisfactory proof of exemption or self-insurance as
authorized under the Workers’ Compensation Act. Certificate of Workers’ Compensation Insurance will
be required for all registrations with commercial endorsements. (REQUIRED: Construction Industries
Board must be listed as a certificate holder.)
c. Every applicant's business name must currently be registered with the Oklahoma Secretary of State
(405) 521-4211. You must submit at least one of the following documents issued by the Oklahoma
Secretary of State:
Certificate of Record of Trade Name
Certificate of Record of Fictitious Name
Certificate of Good Standing (*Must be updated annually*)
d. Information on the legal business entity including, but not limited to, the articles, organizational agreements
or documents establishing the legal business entity, and a list of the officers, members, managers, partners,
or other managing agents of the legal entity.
(*Initial Applications only unless requested by the Registrar*)
e. Affidavit verifying lawful presence in the United States.
f. Any other additional information as requested by the Registrar.
===========================================================================
Certificate Holder must be shown as: For timely processing please include the following:
Construction Industries Board [Qualifying Party Name]/[Business Name] [Registration No.]
2401 NW 23rd Street, Suite 2F [Business Address]
Oklahoma City, OK 73107 [City], [State] [ZIP Code]
Revised May 2018 2
ROOFING CONTRACTOR REGISTRATION
All qualifying parties must be at least eighteen (18) years of age or older.
All qualifying parties must be an officer or owner of the corporation, a member of the limited
liability company, or a general partner of the limited liability partnership, who is actively engaged in
the work undertaken by the registrant for which a registration is required pursuant to the Roofing
Contractor Registration Act and who meets the experience and ability requirements for registration
on behalf of the registrant. See 59 O.S § 1151.2 (12).
All registrations and commercial endorsements shall be nontransferable.
It is unlawful for any person to act as a roofing contractor without having a current and valid roofing
contractor’s registration, or act as a commercial roofing contractor without a current and valid
commercial endorsement issued, pursuant to the Roofing Contractor Registration Act.
* Roofing contractors who do not perform commercial roofing contractor work and only perform
residential roofing contractor work do not need to obtain a commercial endorsement. *
REQUIREMENT: YOU MUST FIRST OBTAIN and/or HAVE AN OKLAHOMA ROOFING
CONTRACTOR REGISTRATION THAT IS IN GOOD STANDING BEFORE APPLYING FOR A
COMMERCIAL ROOFING CONTRACTOR ENDORSEMENT.
===========================================================================
COMMERCIAL ENDORSEMENT
Once the Construction Industries Board has approved your application, the qualifying party’s information
will be submitted to PSI for testing information. You will receive notification from PSI on study
reference material, testing fees, testing sites and testing dates. You may contact PSI directly by phone at
1-800-733-9267 or online at www.psiexams.com. Exam fees are paid directly to PSI when you
schedule your test.
All commercial endorsement applicants are required to pass the Oklahoma Commercial Roofing
Contractor Endorsement exam, which includes a technical trade portion and a business and law
portion, to gain a commercial endorsement on their registration.
Any applicant initially failing to pass the examination shall not be permitted to take another
examination for a period of thirty (30) days. Any applicant subsequently failing to pass the
examination shall not be permitted to take another examination for a period of ninety (90) days.
WORKER’S COMPENSATION INSURANCE
All commercial roofing contractors shall maintain worker’s compensation insurance coverage satisfactory
under the Workers' Compensation Act and pursuant to Title 59 § 1151.22 on all commercial roofing
contractor work.
CONTINUING EDUCATION:
Roofing Contractors holding a Commercial Endorsement must complete at least four (4) hours of
continuing education every three (3) years or thirty-six (36) months. An endorsee is excluded from the
continuing education requirement for three (3) years from the date he or she passed their current
endorsement exam.
NOTE: Any commercial endorsement which remains expired for longer than one (1) year shall not be
renewed. The former endorsement holder shall be required to make an initial application and retest to
obtain the commercial endorsement formerly held. See OAC 158:85-9-1(c)(2).
Revised May 2018 3
Construction Industries Board
2401 N.W. 23rd Street, Suite 2F
Oklahoma City, OK 73107
Telephone: (405) 521-6550
APPLICATION --
ROOFING CONTRACTOR REGISTRATION AND,
IF APPLICABLE, COMMERCIAL ENDORSEMENT
(Important: Registration Fee Plus Any Applicable Endorsement Fee,
Late/Reinstatement Fee Must Accompany Application)
Date of application: __________________
Check all that apply
Roofing Registration: Initial ☐ Renewal of Registration ☐ (If Renewal) Registration #: _______________
Commercial Endorsement: Initial ☐ Renewal of Commercial Endorsement ☐
Qualifying party must check one:
Resident Contractor: ☐ Non-Resident Contractor: ☐
Type or print in ink all information (Every question must be answered; if not applicable place N/A).
Individual qualifying party information:
1. Name: _________________________________________________________________________________________
First Middle Last
2. Physical Address: ________________________________________________________________________________
Street City State Zip
3. Mailing Address: ________________________________________________________________________________
Street/PO Box City State Zip
4. Telephone: ( _____ ) ____________________ ( _____ ) __________________ ( _____ ) __________________
Residential/Cell Business Phone Business Fax
5. Email Address: __________________________________________________________
6. Birthdate: _____/_____/_____ SSN: ________/________/________ Gender: Male____ Female____
Business information:
7. Business Name:______________________________________________________________________________
8. Trade Name (Doing Business As) :__________________________________________________________________
9. Business Mailing Address:______________________________________________________________________
Street/PO Box City State Zip
Office Use Only (Do Not Mark in This Section)
Roofing Contractor Registration ☐
Commercial Endorsement ☐
Approved: __________________ Denied: _______________
Revised May 2018 4
10. Type of Business Entity: Corporation ☐ LLC ☐ LLP ☐ Partnership ☐ Sole Proprietorship ☐
11. State of Formation: _________________________ 12. Percentage of Ownership:____________
13. Number of employees: _______________ 14. If employees are relatives, number:_____________
15. Date Last Oklahoma Income Tax Return was Filed :
For Qualifying Party: _______________ Date Filed ____________
Tax Year Filed Month/ Year
For Business: _______________ Date Filed _____________
Tax Year Filed Month/ Year
16. Federal Tax ID No. if Different from SSN:__________________________
17. Employment Security Commission No.:_____________________________
18. Authorized Persons to Act on Behalf of Business in addition to Qualifying Party:
(attach additional sheets if necessary.)
Name: _____________________________________________________________________________________
Address: ___________________________________________________________________________________
___________________________________________________________________________________________
Telephone: ________________________________ Cell Phone: _______________________________________
Email address: ______________________________________________________________________________
19. Brief description of experience and qualifications of the qualifying party:___________________________________
_________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
20. Has the qualifying party or entity seeking registration herein ever been licensed or registered as a roofing
contractor in a state other than Oklahoma?
☐ Yes ☐No
If yes, please list all states where such license or registration is/was held and whether each license or registration is
currently in good standing.
__________________________________________________________________________________________
__________________________________________________________________________________________
21. Has the qualifying party or entity seeking registration herein ever been disciplined, fined, sanctioned, cited or had
its license or registration to perform work as a roofing contractor suspended or revoked in any state other than
Oklahoma?
☐ Yes ☐ No
If yes, please specify the State of such event and nature of occurrence and date of action taken. (Attach additional
sheets if necessary.)
______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Revised May 2018 5
22. Have you ever been convicted of a felony offense in this State, another State, or any other place? ☐ Yes ☐ No
If yes, list the date, court of conviction, offense by each count(s), sentence for each such conviction and date of sentence
completion, including any probation, parole or supervision period. (Attach additional sheets if necessary.)
59 O.S. § 1151.6(B) Conviction of an offense shall not disqualify a person from registration as a roofing contractor
under this act; provided, the applicant has truthfully disclosed the conviction and nature of the offense.
Date
Court of
Conviction
Offense by Each
Count
(List each.)
Sentence for Each Such
Conviction
Date of Sentence Completion
(Include any probation, parole or
supervision period.)
23. Are you required by the laws of the State of Oklahoma, any other State, or the United States to register as a sex
offender?
☐Yes ☐ No
If yes, you must by law, be registered as a sex offender in the State of Oklahoma pursuant to Title 57 Section 581, et
seq. of the Oklahoma Statutes.)
24. If you answered yes to question 23, have you registered with the State Of Oklahoma?
☐ Yes ☐ No
25. Qualifying party, by signing below, hereby declares under oath that this application, related forms and all
supplemental materials submitted herewith, and the information contained therein, are true and correct.
Further, by submitting this application and signing below, the qualifying party further declares under oath that the
following statements are true and correct.
Qualifying party desires registration and, if applicable, commercial endorsement under the Oklahoma Roofing
Contractor Registration Act.
Qualifying party has read and agrees to fully comply with the Oklahoma Roofing Contractor Registration Act and
Roofing Contractor Registration Regulations.
Qualifying party has submitted all taxes due in this state.
Qualifying party agrees to fully comply with all Oklahoma laws and local ordinances pertaining to roofing
standards and permits.
Qualifying party and proposed registered entity, if a non-resident and/or foreign corporation, agree that the
filing of this application appoints the Secretary of State as the legal service agent for said registered entity for
all lawful process for work performed in Oklahoma or for any purpose set forth in the Roofing Contractor
Registration Act.
Qualifying party affirms that they are in compliance with the Oklahoma Workers' Compensation Act.
Qualifying Party’s Signature: _________________________________ Date: ____/______/______
State of ________________
County of ______________
Subscribed and sworn to or affirmed before me this _______ day of ____________________, 20_____,
by____________________________________________.
[Name of Qualifying Party]
____________________________
Signature of Notary
My Commission Expires: ______________________
My Commission Number: _______________________
(Notary Seal)
Revised May 2018 6
Instructions for Required Affidavit:
All natural persons fourteen (14) years of age or older and present in the United States, applying for a
license with the Oklahoma Construction Industries Board are required, by the provisions of 56 O.S. § 71,
to provide the Board with verification of lawful presence in the United States by executing one of the
Affidavits below before a notary public or other officer authorized to notarize affidavits under State law.
The Board’s licensing offices are staffed with notaries who are available to provide notary service at no
cost to Qualifying parties.
AFFIDAVIT VERIFYING LAWFUL PRESENCE IN THE UNITED STATES
Affidavit of
_________________________________ STATE OF ________________ )
[Qualifying Party's Full Legal Name] ) ss:
COUNTY OF _______________ )
I, ____________________________, of lawful age, being first duly sworn, upon oath state, under
[Qualifying Party's Full Name]
penalty of perjury, as follows:
Please check the appropriate box:
Option 1: I am a United States Citizen.
Option 2: I am a qualified alien under the federal Immigration and Naturalization Act, and I
am lawfully present in the United States.
For this Option, a copy of a valid immigration document which reflects the
qualifying party’s “A” number or “I-9” number must accompany this Affidavit.
___________________________________
Signature of Qualifying Party
Subscribed and sworn to or affirmed before me this _____ day of ____________, 20____,
by _____________________________________________.
[Qualifying Party's Name – Please Print]
____________________________
Signature of Notary
My Commission Expires: _________________
My Commission Number: ________________ (Notary Seal)
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CONSTRUCTION INDUSTRIES BOARD InitialRenewal Application for Roofing Contractor (Oklahoma)

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Completed 22 October 2021

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