Fillable Contractor Examination Application and Fees (Brevard County Board of Commissioners)

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Contractor Examination Application and Fees (Brevard County Board of Commissioners)

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Contractor Exam App 03232020
Planning and Development Department
Licensing Regulation & Enforcement
2725 Judge Fran Jamieson Way, Bldg. A-114
Viera, Florida 32940
Phone: (321) 633-2058, press #4, #6
www.BrevardFL.gov/PlanningDev
Contractor Examination Application and Fees
Application Fees are Non-refundable
Application fees for the following trades are $110.
5 Years documented experience on enclosed Employer Experience Verification Affidavit are required
for the following trades:
Electrical
Mechanical
Plumbing
Roofing
Sheetmetal
Air Conditioning
Class A Unlimited
Class B Limited
4 Years documented experience on enclosed Employer Experience Verification Affidavit are required
for the following trades:
Drywall
Electrical Sign
Limited Energy Systems
Marine I
Marine II
Solar Water Heating
Specialty Structure Aluminum
Swimming Pool Unlimited
Swimming Pool Service
Underground Utility
Alarm Contractors
Alarm Systems I
Alarm Systems II
3 Years documented experience on enclosed Employer Experience Verification Affidavit are required
for the following trades:
Demolition
Excavation (Land Clearing)
Framing/Carpentry
Floor Covering
Floor Covering with Tile
Garage Doors
Masonry
Storm Shutter
Stucco
Swimming Pool Finish
Window and Door
1 Year documented experience on enclosed Employer Experience Verification Affidavit are required
for the following trades:
Irrigation
Fencing
Painting
Application Fees for the following three trade classifications are as follows and require 4 years
documented experience.
General $150
Building $130
Residential $120
For detailed trade definitions, please see Municode Chapter 22, Article 6:
https://library.municode.com/fl/brevard_county/codes/code_of_ordinances?nodeId=PTIICOOR_CH22BUBURE
Contractor Exam App 03232020
Experience Requirements
Has received a baccalaureate degree from an accredited four (4) year college in the appropriate field of
engineering, architecture, or building construction and has two (2) years of proven experience in the
trade category. A minimum of 2,000 hours shall be used in determining full-time equivalence.
Or
Has a total of at least four (4) years of active experience as a skilled workman who is able to command
the pay rate of a mechanic in his particular trade or as a foreman who is in charge of a group of workmen
and usually responsible to a superintendent or a contractor or his equivalent, provided, however, that at
least one (1) year of active experience shall be as a foreman.
Or
A combination of not less than one (1) year of experience as a foreman and not less than three (3) years
of credits for any accredited college-level courses in the appropriate trade.
Or
Has a combination of not less than one (1) year of experience as a skilled workman, one (1) year of
experience as a foreman and not less than two (2) years of credits for any college level courses in the
appropriate trade.
Or
Has a combination of not less than two (2) years of experience as a skilled workman, one (1) year of
experience as a foreman and not less than one (1) year of credits for any college level courses in the
appropriate trade.
Or
Provide evidence of a minimum of five (5) years of practical experience in the trade or have an active
journeyman license for three (3) years.
For the number of years of credits for any college level courses, the applicant shall show completion of
an equal number of courses in the appropriate field of engineering, architecture, or building construction.
All junior college or community college level courses shall be considered accredited college level
courses.
Proof of schools, apprenticeship programs, including dates, diplomas, letters and other pertinent
information and recommendations must be provided.
The Contractors' Licensing Board may, in its sole discretion, consider a person's formal or vocational
education as practical experience in the trade if the education is in the trade for which the person is
applying.
Experience must be documented in writing by your employer(s) (past or present) for proof of
experience. More than one experience form may be used. All documents must be originals.
Contractor Exam App 03232020
Brevard County
Licensing Regulation & Enforcement
2725 Judge Fran Jamieson Way, Suite A-114
Viera, FL 32940
Phone (321) 633-2058, press 4, then 6
Contractor Examination Application and Fees
The following documents must be submitted with application:
• Application Fee as indicated on page one (1)
o Make checks payable to Board of County Commissioners
• Copy of valid driver’s license or government issued ID
• Three (3) letters of recommendation from contractors whom applicants have worked
either for or with, or reputable business or professional people, not related by blood
or marriage to the applicant, vouching for the applicant’s reputation as to honesty,
integrity and good moral character. Letters must be notarized and on letterhead.
• Letters must be originals. faxes or copies will not be accepted.
• Notarized documentation of experience on attached Experience Form.
• Signed Social Security Number Disclaimer.
Selected Trade: ________________________
Application Fee: ________________________
Do Not Write in This Space
DATE CAP ID PYMT TYPE INVOICE # STAFF
Contractor Exam App 03232020
Contractor Application for Exam
1. Name: (last, first, MI) _____________________________________________________________
2. Street Address: _________________________________________________________________
City ______________________________ State ____________________ Zip _______________
3. Date of Birth ____________________________ Email __________________________________
4. Business Phone # _________________________ Home # _______________________________
5. U S Citizen? Yes No
If no, provide copy of front & back of valid residency or work documentation.
6. Do you presently have a current city or county business tax receipt? Yes No
If yes, where? ________________________________________________
If yes, Company Name _________________________________________
7. List your COMPLETE residential addresses for the past five years (street, city, state, zip):
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
8. List all businesses you have owned, operated, or managed or have had an interest of any kind during
the past five years:
Business Name Complete Business Address Position
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Contractor Exam App 03232020
Contractor Application for Exam
9. Have you undertaken construction contracts or work that a third party, such as a bonding or surety
company, completed or made financial settlements?
Yes No If yes, provide a written statement of explanation.
10. Have you had claims or lawsuits filed for unpaid or past due accounts by your creditors as a result of
construction operations?
Yes No If yes, provide a written statement of explanation.
11. Have you undertaken construction contracts or work which resulted in liens, suits or judgments being
filed?
Yes No If yes, provide a written statement of explanation.
12. Have you had a lien filed against you by the U.S. Internal Revenue Service or Florida Corporate Tax
Division?
Yes No If yes, provide a written statement of explanation.
13. Have you made an assignment of assets in settlement of construction obligations for less than the
debts outstanding?
Yes No If yes, provide a written statement of explanation.
14. Have you been charged with or convicted of acting as a contractor without a license, or if licensed as
a contractor in this or any other state, been subject to any disciplinary action by state, county or
municipality?
Yes No If yes, provide a written statement of explanation.
15. Have you filed or been discharged in bankruptcy within the past five years?
Yes No If yes, provide a written statement of explanation.
16. Have you been convicted or found guilty of, or entered a plea of nolo contendere to, regardless of
adjudication, a crime in any jurisdiction within the past ten years?
Yes No If yes, provide a written statement of explanation.
17. Notwithstanding the above, have you ever at any point in time had a felony conviction that has
resulted in the revocation of your civil rights?
Yes No If yes, provide a written statement of explanation.
Applicant may be required to provide further information or appear before the Contractors' Licensing
Board.
Contractor Exam App 03232020
Contractor Application for Exam
Brevard County and the Construction Industry Licensing Board Rule 61G4-15.005 establishes
minimum net worth requirements for the following categories of contractors.
$20,000 Minimum Net Worth for the following:
General Contractor
Class I
Building Contractor
Class II
Residential Contractor
Class III
$10,000 Minimum Net Worth for the following:
Alarm I
Alarm II
Electrical
Electrical Sign
Limited Energy Systems
Mechanical
Plumbing
Roofing
Sheet Metal
Solar Water Heating
Specialty Structure
Underground Utility
Swimming Pool
HARV Class A Unlimited
HARV Class B Limited
$2,500 Minimum Net Worth for the following:
Demolition
Drywall
Excavation
Fencing
Floor Covering
Floor Covering w/Tile
Framing/Carpentry
Garage Doors
Irrigation
Marine I
Marine II
Masonry
Painting
Storm Shutter
Stucco
Swimming Pool Finishing
Swimming Pool Service
Window & Door
Net worth shall be defined to require a showing for all contractor licensure categories that
the applicant has a minimum of 50% of the amount in cash.
Please complete the following financial section:
Items marked with ** are Required
PERSONAL ASSETS PERSONAL LIABILITIES
Accounts Payable
Notes Payable
Accruals
Mortgages (if related to business)
Capital Stock (if incorporated)
Other
Total Liabilities:**
NET WORTH**
(Total Assets less Total
Liabilities)
I certify that I meet the minimum net worth requirements.
______________________________________________ _________________________
Applicant’s Signature Date
Contractor Exam App 03232020
Contractor Application for Exam
EMPLOYMENT / EDUCATION INFORMATION – TO BE COMPETED BY THE APPLICANT
Present Employer _______________________________________ Phone # __________________
Street Address _____________________________________ City __________________________
State _______________ Zip ________________ Position Held _____________________________
Hire Date: _______________________ Termination Date: _____________________________
Previous Employer ____________________________________ Phone # ____________________
Street Address _____________________________________ City ___________________________
State _______________ Zip ________________ Position Held _____________________________
Hire Date: _______________________ Termination Date: ______________________________
Previous Employer ____________________________________ Phone # ____________________
Street Address _____________________________________ City ___________________________
State _______________ Zip ________________ Position Held _____________________________
Hire Date: _______________________ Termination Date: ______________________________
Previous Employer ____________________________________ Phone # ____________________
Street Address _____________________________________ City ___________________________
State _______________ Zip ________________ Position Held _____________________________
Hire Date: _______________________ Termination Date: ______________________________
Additional Experience:
Total years as a Helper: ___________ Total years as a Licensed Journeyman: ____________
Total years as a Foreman: __________ Total years as a Licensed Master: ____________
Total years on the job hours in approved apprenticeship program: *
Apprenticeship School Name:
Apprenticeship School Address:
Other Education, School or Degrees:
* Provide documentation
Contractor Application for Exam
Applicant Experience Verification Affidavit
If you are the owner and operator of the business, this form is to be completed by the applicant
and submitted with your application to provide information regarding your experience. It will be
used to support your qualifications. Detailed and specific information is required. It becomes the
property of Licensing Regulation & Enforcement when submitted. Please complete and return
with the application.
If you are not the owner of the business but have authority from the owner and have working
knowledge of the business, the Employer Verification Affidavit must accompany this
application, signed by the owner.
Applicant Name _____________________________ Trade Classification _____________________
Business Tax Receipt #, if applicable ________________________
Applicant experience Start Date ______________________ End Date _______________________
I certify that I have performed work as a contractor in the previously listed trade category as my
primary occupation for the duration given and I attest to the following experience:
Describe in Detail:
Describe work performed (be specific):
Type of buildings, structures, job projects worked on (be specific):
Other pertinent information:
Contractor Exam App 03232020
Contractor Application for Exam
The undersigned hereby makes application for certification in accordance with the provisions of
Chapter 22, Code of Brevard County, Florida.
I certify I will act only for myself or that I am legally qualified to act on behalf of the business
organization seeking to be qualified and certified, in all matters connected with its contracting
business. Furthermore, I have the authority to supervise construction projects undertaken by myself
or the business organization qualified and certified and will continue during this certification to be able
to so bind said business organization. If I sever my affiliation with said business organization, I will
immediately notify the Contractor Licensing Board in writing within thirty (30) days of such
termination. Initial _________
I authorize the secretary to the Brevard County Contractor Licensing Board to obtain from any source
dealing with me, even though confidential, such additional information concerning my financial
condition as may be deemed necessary by the Board. Initial _________
I acknowledge that pursuant to Brevard County Code and Florida Statute 489, I am personally
responsible for all the financial affairs of the business I am applying to qualify. I realize this includes
“financial matters,” both for the organization in general and for each specific job.
Initial _________
I also acknowledge that I will personally supervise all work being done or there will be a certified
master or journeyman, if applicable, on the site at all times. Initial _________
I authorize investigation of all statements contained in this application. I understand that
misrepresentation or any omission of facts called for is cause for disciplinary action by the Brevard
County Construction Industry Licensing Board. I also authorize release of sheriff and police records to
the Brevard County Licensing Regulation & Enforcement agency. Initial _________
I hereby release you, your organization or others from any liability for damage which may result from
furnishing the information requested above. Initial _________
I agree to familiarize myself and abide with all local ordinances and amendments, state regulations
and the Florida Building Code governing all restrictions in reference to the license I have been issued
Initial _________
I certify that this information is true and correct to the best of my knowledge and that any willful
falsification of any information contained herein is grounds for disqualification.
Signature of Applicant __________________________________ Date _____________________
STATE OF ________________________
COUNTY OF _____________________
The foregoing instrument was acknowledged before me this ______ day of ________________,
20______, by _____________________________________ who is personally known to me _____
or who produced a ________________________________________ as identification.
(Notary Seal)
_________________________________
Signature of Notary
EMPLOYER EXPERIENCE VERIFICATION AFFIDAVIT
This applicant is requesting that you certify as to your knowledge of his/her experience as your
employee by completing this form. The attached form is used in support of the applicant’s
qualifications. Details and specific information is required. This form becomes the property of
Contractor Licensing when it is submitted. Please complete and return to the applicant.
Applicant’s Name __________________________________________________________________
Classification _____________________________________________________________________
Address _________________________________________________________________________
Contractor/Supervisor’s Name ______________________________ License # _________________
Applicant employment Start Date ______________________ End Date _______________________
I certify that I employ(ed) Applicant from dates shown above and I know of my own direct knowledge
that said applicant was employed as follows:
DESCRIBE IN DETAIL
Positions held (include dates):
Describe work performed (be specific):
Experience Form
Type of buildings, structures, job projects worked on (be specific):
Other pertinent information (schools, apprenticeship programs, etc):
EXPERIENCE VERIFIED BY:
Print Name ________________________________ Position/Title ___________________________
Address _________________________________________________________________________
Daytime phone # ____________________________
I certify that this information is true and correct to the best of my knowledge and that any willful
falsification of any information contained herein is grounds for disqualification.
_____________________________________________ License # ___________________________
(Signature of Contractor/Supervisor)
STATE OF ______________________
COUNTY OF _____________________
The foregoing instrument was acknowledged before me this ______ day of ________________,
20______, by _____________________________________ who is personally known to me _____
or who produced a ________________________________________ as identification.
(Notary Seal)
_________________________________
Signature of Notary
SOCIAL SECURITY NUMBER DISCLAIMER
** "Under the Federal Privacy Act, disclosure of Social Security numbers is voluntary unless
specifically required by Federal statute. In this instance, Social Security numbers are mandatory
pursuant to Title 42 United States Code, Sections 653 and 654; and Sections 455.203(9); 409,2577,
and 409.2598, Florida Statutes. Social Security numbers are used to allow efficient screening of
applicants and licensees by a Title IV-D child support agency to assure compliance with child support
obligations. Social Security numbers must also be recorded on all professional and occupations
license applications and will be used for licensee identification pursuant to the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996 (Welform Reform Act), 104 Pub.L. 193, Sec.317."
You must print your name, Social Security Number, date and sign that you have read the disclaimer
above:
________________________ ________________________
(Print Name) (Social Security Number)
__________________________________ Date ___________________
(Sign)
Please cut along dotted line and keep bottom portion of the disclaimer for your records
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
** "Under the Federal Privacy Act, disclosure of Social Security numbers is voluntary unless
specifically required by Federal statute. In this instance, Social Security numbers are mandatory
pursuant to Title 42 United States Code, Sections 653 and 654; and Sections 455.203(9); 409,2577,
and 409.2598, Florida Statutes. Social Security numbers are used to allow efficient screening of
applicants and licensees by a Title IV-D child support agency to assure compliance with child support
obligations. Social Security numbers must also be recorded on all professional and occupations
license applications and will be used for licensee identification pursuant to the Personal Responsibility
and Work Opportunity Reconciliation Act of 1996 (Welform Reform Act), 104 Pub.L. 193, Sec.317."
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Contractor Examination Application and Fees (Brevard County Board of Commissioners)

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