Fillable CONTRACTORS LICENSE BOARD (Island of Guam)

Fill Online, Printable, Fillable, Blank CONTRACTORS LICENSE BOARD (Island of Guam) Form

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

CONTRACTORS LICENSE BOARD (Island of Guam)

On average this form takes 20 minutes to complete

The CONTRACTORS LICENSE BOARD (Island of Guam) form is 17 pages long and contains:

  • 0 signatures
  • 13 check-boxes
  • 75 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Island of Guam forms online.

BROWSE ISLAND OF GUAM 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
 
CONTRACTORS LICENSE BOARD
Inetnon Malisensiayen Kontratista
542 North Marine Corp Drive, Bldg. A • Tamuning, Guam 96913
Tel: (671) 649-2211 / 9676 • Fax: (671) 649-2210 • http://www.clb.guam.gov
LOURDES A. LEON GUERRERO CECIL “BUDDY” L. ORSINI
GOVERNOR EXECUTIVE DIRECTOR
JOSHUA F. TENORIO
LT. GOVERNOR
March 02, 2020
Buenas Yan Saludas,
The Office of the Contractors License Board (CLB) will begin the process of clearing all
“2021 License Application Renewals” beginning March 15, 2020. Please be advised that
failure to pay Inactive License Fees or to “RENEW” your license on or before June 30, 2020
shall automatically constitute a forfeiture of your license. At this time, you may visit or call the
In order to effectively renew for active status for License Year 2020, you must proceed to the
following agencies for clearances:
• Department of Revenue and Taxation
4 stamps required - Business License Section, GRT Section, Income Tax Section, Collection.
• Department of Labor (G.C.I.C. Bldg. Hagåtña)
5 stamps required - OSHA On-Site, Bureau of Labor Statistics, Wage & Hour,
Worker’s Compensation, *Alien Labor Processing & Certification.
• Department of Land Management – 3rd floor ITC Building (Planning Division)
• Department of Public Works – The Permit Center (DPW)
• Department of Public Health – Only for H2 Barracks
• Professional Engineers, Architects, Land Surveyors (P.E.A.L.S.) Board – 2nd Floor, East-West
Also required is a proof of financial solvency. This is a bank letter of credit attesting to solvency
or a financial statement from your bank. A sample form is attached to print and to provide your financial
If in need of fu
rther assistance, please contact the Guam Contractors License Board Office at (671)
649-2211 or 649-9676.
Dångkolo Na Si Yu’os Ma’åse’
CECIL “BUDDY” L. ORSINI
Executive Director
T
A
N
O
I
M
A
N
C
H
A
M
O
R
R
O
CLB for more information and to pick up the “2021 License Application Renewal” form.
Building, Upper Tumon (If Contractors has “A” Classification)
institution for review. Additionally proof of Workers Compensation Insurance is required.
2021 RENEWAL APPLICATION
Instruction & Information Sheet
Please read before completing the application for renewal.
If you have any question, please contact our office at 647-2965, 649-2211 or 649-9676.
DEFINITION OF LICENSE TYPES
SOLE PROPRIETOR LICENSE: A license issued to an individual who passed the examination and opened his or
her own company. Sole proprietors are required to complete Parts I, II & III of the renewal application.
SOLE PROPRIETOR WITH RESPONSIBLE MANAGEMENT EMPLOYEE (RME) LICENSE: A license issued
to an individual who opens his or her own company but hires another individual who passed the examination
to represent his or her company as the RME. Sole Proprietors with Responsible Management Employees are
required to complete all parts of the renewal application.
PARTNERSHIP LICENSE: A license issued to a company owned by two (2) or more individuals. All partnerships
must be registered with the Department of Revenue and Taxation. The partnership must hire an individual who
passed the examination to be the RME or one of the owners must pass the examination on behalf of the partnership.
Partnerships are required to complete Parts I, III & IV of the renewal application.
CORPORATION LICENSE: A license issued to companies registered with the Department of Revenue and Taxation
as a Corporation. Like partnerships, the corporation must hire an individual who passed the examination to be the
RME or have one of the corporate officers pass the examination on behalf of the corporation. Corporations are
required to complete Parts I, III & IV of the renewal application.
JOINT VENTURE LICENSE: A license issued when two (2) currently licensed companies work together
. The joint
venture may be for particular projects only or may be for all work undertaken by each company. Joint Ventures are
required to complete Parts I, III & IV of the renewal application.
PART I – COMPANY INFORMATION
If your company has a fictitious name (dba) you must reflect the full name of the corporation on the application and
it must be registered as well with the Department of Revenue and Taxation.
Example: XYZ Corporation (dba) Zee Construction Company.
The classifications of a company are always the same as the classification of its responsible management employee.
If a company has more than one (1) RME, then the company’s classifications are a combination of all its RMEs
classifications.
PART II –OWNER INFORMATION
Please ensure that all information is provided. If any information is a duplication of the company information “DO
NOT USE”.
PART III- QUESTIONS
with “yes” answer. Failure to answer may delay the process of your application.
PART IV- RESPONSIBLE MANAGEMENT EMPLOYEE (RME)
The license number of the RME is always different from the company’s license number.
Exception: Sole Proprietor License.
Please ensure that all information pertaining to the RME is provided. Residential addresses should have a
house number, street name, and village. Lot numbers will not be accepted as the residential address. In addition,
email address, residential phone numbers, mobile and pager numbers are also requested. Be assured that the
information will be for the use of our Agency. Only information on the companies that the RME represents will
be given to the general public.
AGENCY CLEARANCE FORMS
Clearance from all agencies listed on the Agency Clearance Form is required. Failure to obtain complete clearances
will delay the renewal process.
REQUIRED DOCUMENTS: Upon completion of the application and obtaining clearances, the
following documents must be provided to our office in order to process your application. Please note
that our office will not make copies. You must furnish our office with a copy of each of the following
documents:
PROOF OF WORKERS COMPENSATION INSURANCE: Companies that have employees, part-
time or full-time, must obtain workers compensation insurance. In the event that a corporate officer
or partner is the RME of the company, workers compensation insurance for the RME is required if the
RME does not own 51% or more of the company.
FINANCIAL SOLVENCY STATEMENT:
financial statement. A sample form has been provided for your financial institution to review.
PROJECT LISTING: A complete listing of all projects, requiring a building permit, obtained between
July 1, 2018 and June 30, 2019.
PAYMENT
Receipts must first be picked up at the CLB office. Payments may then be made at the TREASURER OF GUAM
between the hours of 8:00 a.m. to 12:00 p.m. and 1:00 p.m. to 5:00 p.m. Monday to Friday, except on holidays.
***CLB WILL CHARGE $1.00 FOR EACH COPY MADE THROUGH THE OFFICE***
FEE SCHEDULE
LICENSE FEES FOR COMPLETED RENEWAL APPLICATIONS
PROCESSED BETWEEN MARCH 15, 2020 & JUNE 30, 2020
Sole Proprietor: $450.00
Sole Proprietor with RME: $900.00 ($450.00 for each additional RME)
Partnerships: $900.00
Corporation with 1 RME: $900.00 ($450.00 for each additional RME)
Joint Venture: $900.00
LICENSE FEES FOR COMPLETED RENEWAL APPLICATIONS
PROCESSED AFTER JUNE 30, 2020
Sole Proprietor: $495.00
Sole Proprietor with RME: $990.00 ($495.00 for each additional RME)
Partnerships: $990.00
Corporations with 1 RME: $990.00 ($495.00 for each additional RME)
Joint Venture: $990.00
All corporation, joint ventures, and partnerships must qualify or hire an individual as a Responsible
Management Employee (RME).
Guam Contractors License Board [ ] Sole Proprietor – Complete Part I, II & III
542 N. Marine Corp. Drive – A [ ] Sole w/RME - Complete All Parts
Tamuning, Guam 96913 [ ] Partnership – Complete Part I, III & IV
Tel: 646-7262/649-2211/649-9676 [ ] Corporation – Complete Part I, III & IV
Fax: 649-2210 [ ] Joint Venture – Complete Part I, III & IV
Application for Renewal - License Year 2021
Guam Contractors License Board [ ] Sole Proprietor – Complete Part I, II & III
542 N. Marine Corp. Drive – A [ ] Sole Proprietor w/RME-Complete All Parts
Tamuning, Guam 96913 [ ] Partnership – Complete Part I, III & IV
646-7262;649-2211;649-9676;649-2210 (Fax) [ ] Corporation – Complete Part I, III & IV
Application for Renewal- License Year 2009 [ ] Joint Venture – Complete Part I, III & IV
PART I – COMPANY INFORMATION
** Name of Company ** Company License
No. #
** GRT Number
** Mailing Address:
** Office Phone **Alternate Phone ** Fax ** Cell Phone ** E-Mail Address
** Office Location ( Example: 123 S. Street Name, Tamuning, Guam) DO NOT USE LOT NUMBER OF POST OFFICE BOX ADDRESS
** Classification(s)
PART II – OWNER INFORMATION (If company is a Corporation, Partnership, or Joint
Venture, DO NOT COMPLETE THIS SECTION-GO DIRECTLY TO PART III.
**Name of Owner **Social Security Number
**Residential Address
(DO NOT USE LOT NUMBERS OR POST OFFICE BOX- USE HOUSE NUMBER, STREET NAME & VILLAGE)
**Home Phone **Cell Phone Pager ** E-Mail Address
PART III – ALL OF THE FOLLOWING QUESTIONS MUST BE ANSWERED. Attach a
detailed statement identifying the transaction, and include the names and addresses of the
parties involved for each “YES” answer.
1.
Are there any unpaid, past due bills or claims for labor, material, or services, as a result of any construction
contract or work undertaken by you or the company? [ ] Yes [ ] No
2. Are there any liens, suits, or judgments of record pending as a result of any construction contract or work
undertaken by you or the company?
[ ] Yes [ ] No
3. Are there any judgments or admitted claims against any bond or cash deposit required by Law, posted by
the company or owner or share holder(s)? [ ] Yes [ ] No
I/We certify, under penalty of perjury under the laws of Guam that the information provided above and all
supplementary statements are true and correct. I/We also authorize the Contractors License Board to access,
inquire or obtain information necessary in order to process my/
our application for the purpose of obtaining a
license from their office.
_____________________________ ______ ______________________________ ______
Signature of Owner/Partner/Corporate Officer Date Signature of Owner/Partner/Corporate Officer Date
________________________________________ _________ _________________________________________ ________
Signature of Owner/Partner/Corporate Officer Date Signature of Owner/Partner/Corporate Officer Date
** Required fields: Application will
not be accepted without this information.
All corporations, joint ventures, and partnerships must qualify or hire an individual as a
Responsible Management Employee (RME). The following section pertains to the
individual who will serve as the RME.
PART IV- RESPONSIBLE MANAGEMENT EMPLOYEE (RME) INFORMATION.
(If there is more than one RME, please make a copy of this form)
** Name of Responsible Management Employee (RME) ** RME’s License No. # ** Social Security Number
**Mailing Address
** Residential Address (DO NOT USE LOT NUMBER OR POST OFFICE BOX ADDRESSES-USE HOUSE NUMBER, STREET NAME AND
VILLAGE)
** Home Phone ** Cell Phone Pager ** E-Mail Address
** Classification(s)
The signature below indicates that ______________________________ hereby appoints the above
individual as the RME of My/our company.
_________________________________
Name of Company
_____________________________________________
Signature of Owner/Partner/Corporate Officer Date
I, the undersigned, accept appointment as the Responsible Management Employee (RME) for the
company stated above. I understand my duties include supervising personnel on construction,
daily inspections of project progress to ensure compliance with the plans, specifications, building
codes, and laws of the Laws of Guam.
I also understand I must provide the Contractors License Board with a written notification of my
dissociation, upon resignation or termination as the RME of the above company, or the company
(ies) listed below. Furthermore, I declare, under penalty or perjury under the laws of the Laws of
Guam, that all statements, information, and representations in this application, are true and
accurate.
In addition to the company above, I am currently the RME for the following company (ies).
*
*Company
**Company
______________________________________
Signature of Responsible Management Employee Date
** Required fields: Application will not be accepted without this information.
Agencies Clearance Form - License Year 2021
Company Name Social Security or Employment
Identification Number (EIN)
Name of Owner or RME GRT Number:
YOU MUST OBTAIN EACH DEPARTMENT AND SECTION LISTED BELOW. IF STAMPS ARE
INCOMPLETE, THE APPLICATION PROCESS MAY BE DELAYED.
DEPARTMENT OF REVENUE AND TAXATION
BUSINESS LICENSE SECTION GRT SECTION INCOME TAX SECTION COLLECTION
DEPARTMENT OF LABOR
OSHA ON-SITE BUREAU OF LABOR STATISTICS WAGE & HOUR WORKER’S COMPENSATION
DEPT. OF LABOR (ALIEN LABOR PROCESSING & CERT. DIV. (ALPCD)
EPT. OF LAND MANGMENT DEPT. OF PUB WORK DEPT. OF PUBLIC HEALTH PEALS BOARD
BUILDING PERMITS (ONLY FOR H-2
BARRACKS) (AClass Only)
DEPARTMENT OF REVENUE AND TAXATION (4 STAMPS)
BUSINESS LICENSE SECTION GRT SECTION INCOME TAX SECTION COLLECTION
DEPARTMENT OF LABOR (5 STAMPS)
OSHA ON-SITE BUREAU OF LABOR STATISTICS WAGE & HOUR WORKER’S COMPENSATION
DEPT. OF LABOR (ALIEN LABOR PROCESSING & CERT. DIV. (ALPCD)
(3RD FLOOR - ITC BUILDING)
DEPT. OF LAND MANGMENT DEPT. OF PUB WORK DEPT. OF PUBLIC HEALTH PEALS BOARD
(PERMIT CENTER) (ONLY FOR H-2 BARRACKS) (A Class)
ZONE CLEARANCE FOR CONTRACTORS LICENSE
(To be attached to contractor’s license application)
THIS FORM MUST BE COMPLETED IN ORDER TO OBTAIN A CLEARANCE FROM
THE DEPARTMENT OF LAND MANAGEMENT. IF YOU ARE LEASING, RENTING
OR USING A LOCATION FOR OFFICE, BARRACKS, EQUIPMENT AND STORAGE
YARD OR STORAGE OF CONSTRUCTION MATERIALS, PLEASE ATTACH ALL OF
THE REQUIRED DOCUMENTS AS SHOWN ON BACK OF THIS FORM.
COMPANY NAME: _______________________________
1. OFFICE LOCATION:
Lot No: Block Number:
Tract No: Municipality:
2. BARRACKS:
Number of Alien Employees: _______ If more the five (5), where are they being housed?
_____________________________________________________________
Lot No: Block Number:
Tract No: Municipality:
3. EQUIPMENT AND STORAGE YARD:
Do you have any heavy equipment? ( ) Yes ( ) No
If yes, where are they parked or stored when not in use:
Lot No: Block Number:
Tract No: Municipality:
4. STORAGE OF CONSTRUCTION MATERIALS:
Lot No: Block Number:
Tract No: Municipality:
I certify that the above information is true and correct.
_______________________ __________________________ __________________
Name (Print) Name (Signature) Date
PROJECT LISTING
Company Name: ________________________________________________RME Name: ________________________________
Company License #: ______________________________________________RME License #: _____________________________
Guam Contractors License Board LICENSE PERIOD COVERED
542 N. Marine Corps Dr. – Bldg. A [ ] July 1, 2019 – June 2020
Tamuning, Guam 96913 [ ] July 1, 2020 – June 2021
Tel: 647-2965/649-2211/9676 • Fax: 649-2210 [ ] July 1, 2021 – June 2022
Signature of Owner / Partner / Corp. Officer
License Period selected above.
Name of Owner / Partner / Corp. Officer Title Date
Client Name & Address
Joe & Ann Salas
P.O. Box 2-A Hagatna, Guam 96900
SAMPLE: 3 Bedroom, 3 Bath
Concrete
$2,000,000.00 XYZ Insurance Co. B05007 Yes ABC Construction Co.
1
2
3
4
5
6
7
8
9
10
11
Description of Contract Contract Amount Bonding Company Permit No. (If any) Primary Contractor Sub-Contractor Name
BANK LETTERHEAD
This information is CONFIDENTIAL and furnished
as a matter of business courtesy in reply to your inquiry.
No responsibility is assumed by the BANK OF GUAM DATE:_____________________________
or its officer.
CONTRACTORS LICENSE BOARD
_______________________________
_______________________________
The information check below is in reply to your recent inquiry regarding
***************************JOHN DOE******************************
And is given in confidence without liability on the part of this bank. It is based solely on
our direct experience with our customer.
____ Enclosed signature compares favorably.
____ Has maintained an account since January 1, 2016
Year to Date $15,000.00
Present Balance $10,000.00
Account Number (s) Savings ACCT # 0102-111111
____ Account has been satisfactory.
_____ Credit relations have been satisfactory.
_____ Unable to locate record of credit relations
_____ Account recently opened. Not yet identified.
_____ Please give full name, address, and line of business as we have similar names.
_____ Please give the name or address of the branch where the subject is known:
otherwise, we are unable to locate this name. We shall be pleased to recheck it
for you upon receipt of this specific reference.
REMARKS:________NONE________________________________________________
________________________________________________________________________
___________________________ __________________________
I, John Doe Joe Cruz
Authorized the Bank of Hawaii Operations Officer
To release information Agana Branch
PROOF OF FINANCIAL SOLVENCY, (BANK LETTER OF CREDIT ATTESTING
TO SOLVENCY OR FINANCIAL STATEMENT FROM THE BANK)
Office Location Map - License Year 2021
Company Name: _______________________________________________________________
RME Name: ____________________________________________________________________
Company License #: ______________________ RME License #: _________________________
Business/Office Address: _________________________________________________________
_______________________________________________________________________________
Mobile #: ___________________Email Address: _____________________________________
PLEASE DRAW A MAP BELOW & SHOW LANDMARKS WITHIN THE VICINITY
The Guam Board of Registration for
PROFESSIONAL ENGINEERS, ARCHITECTS & LAND SURVEYORS
Inetnon Rihestrasion Inheneron Prufisinat, Atketekto yan Agranensot Tano’
East-West Business Center, Unit D- Suite 208 z 718 North Marine Drive, Upper Tumon Guam 96913
Telephone: (671) 646-3115 Fax: (671) 649-9533 z
Website: www.guam-peals.org
DECLARATION AND ACKNOWLEDGMENT
The “Class A - General Engineering Contractor” license is issued under the authority of the Contractors
Licensing Board (“CLB”) in accordance with Chapter 70 (Contractors) of Title 21 (Real Property) of the
Guam Code Annotated (21 GCA §§ 70101, et seq.). The intent of the law establishing the categories or
classes of dierent licenses issued by the CLB was to dierentiate the types of construction for which
contraetors may qualify. The words “General Engineering” as used in the Class A license issued by the
CLB, are intended to denote that type of construction commonly referred to as “horizontal construction,”
and are not intended to authorize any engineering activity which is licensed and regulated by the Guam
Board of Registration for Professional Engineers, Architects and Land Surveyors (PEALS Board).
The PEALS Board maintains strict rules regarding the use of the term “Engineering” and the practice of
oering “engineering services.” Unless a person or company is licensed and registered with the PEALS
Board, oering or advertising engineering services or general engineering is a violation of the law. This
includes, without limitation, use of these words on business cards, newspaper or magazine articles and
advertisements, and phone listings. Specically, 22 GCA § 32102 states (emphasis added):
§ 32102. GENERAL PROVISIONS
In order to safeguard life, health, and property, and to promote the public welfare, the
practice of engineering, architecture and land surveying in Guam is hereby declared to be
subject to regulation in the public interest. It shall be unlawful for any person to practice,
or to oer to practice, engineering, architecture or land surveying in Guam as dened in
the provisions of this Title, or to use in connection with his name or otherwise assume, or
advertise any title or description tending to convey the impression that he is an engineer,
an architect or land surveyor, unless such person has been duly registered or exempted
under the provisions of this Title. The practice of engineering, architecture and land
surveying shall be deemed a privilege granted by the territory through the Guam Board
of Registration for Professional Engineers, Architects and Land Surveyors, based on the
qualications of the individual as evidenced by his certicate of registration, which shall
not be transferable.
I, _____________________________________________________, as the Responsible Managing Employee of
___________________________________________ (name of rm/company), by my signature below, hereby
acknowledge that the issuance of a Class A - General Engineering Contractor license does not authorize
me or the above-named company to engage in, oer, advertise or othetwise perform engineering as a
regulated and licensed by the PEALS Board in accordance with the Professional Engineers, Architects and
Land Surveyors Law (22 GCA §§ 32101, et seq.). I further acknowledge that doing so constitutes a violation
ohe law, subject to all applicable penalties and prosecution authorized by law.
I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF GUAM THAT THE FOREGOING
IS TRUE AND CORRECT.
Acknowledged by: ______________________________________________________
Signature: ______________________________________________________
RME Name: ______________________________________________________
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

CONTRACTORS LICENSE BOARD (Island of Guam)

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 17 June 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document