Fillable Contractor Registration Form Fill In (Village of Whitehouse)

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Contractor Registration Form Fill In (Village of Whitehouse)

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The Contractor Registration Form Fill In (Village of Whitehouse) form is 2 pages long and contains:

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  • 30 check-boxes
  • 19 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Village of Whitehouse

BROWSE VILLAGE OF WHITEHOUSE (OH) FORMS

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CONTRACTOR REGISTRATION FORM
Please Print Clearly
□ New □ Re-Register for 20____
Name of Company: _________________________________________ Date: __________
Contact Name and Title: _____________________________________________________
Business Address: __________________________________________________________
Street City State Zip Code
Telephone No: ______________________________ Fax No: _______________________
E-mail address: ___________________________________________________________
Please check the type of work you are qualified to perform:
□ Commercial □ Residential □ Industrial
□ General Contracting □ Home Builder □ Remodeling □ Roofing
□ Siding □ Windows □ Gutters □ Electrical
□ Plumbing □ HVAC □ Refrigeration □ Sewer
□ Sign Builder □ Fencing □ Landscaping □ Pools
□ Cabinet Builder □ Lawn Sprinklers □ Fire Suppression
□ Concrete/Masonry □ Foundations □ Repairs/Waterproofing
□ Accessory structures □ Hauling □ Other ______________________
1. How many years experience do you having doing the type of work as indicated above?
______________________________________________________________________
2. How long has your company been in business? _____________________________
3. How long has your company been under current ownership? ___________________
(See Page 2 on Reverse Side)
Village of Whitehouse
Building & Zoning Department
6925 Providence Street
PO Box 2476
Whitehouse, OH 43571
Ph: 419-877-5383 . Fax: 419-877-5635
4. Do you have employees? □Yes □No If yes, please provide a copy of your workers
comp certificate.
5. Do you have subcontractors? □Yes □No If yes, each subcontractor must complete
a Contractor Registration Form.
6. If you are a plumbing, electrical, steamfitter, HVAC, refrigeration, or fire suppression
systems contractor, you will need to attach a copy of your State of Ohio registration /
license.
7. Proof of Liability Insurance is required from all Sidewalk, Sewer, and Sign Contractors
who perform work in Whitehouse. If you do not have a copy, your agent can fax a copy of your
certificate of insurance to 419-877-5635.
All contractors doing work in Whitehouse, Ohio must be registered each calendar year. If the
information on this form is found to be satisfactory, a Certificate of Registration will be issued.
Certificate of Registrations are valid for one calendar year:
Original registration per calendar year …………………………………….. $50.00
Re-registration. In order to qualify for the re-registration discount,
Registration forms and payment are due by January 31 of each year …… $40.00
This form must be signed by an authorized person.
Name of Company: ______________________________________________________
Print your name and title: __________________________________________________
Signature: ________________________________________ Date: ________________
FOR OFFICE USE ONLY
Date Received: __________ For Calendar Year: 20___
Method of Payment: ________ Amount: $___________
Check No. ___________ Receipt No. _________
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Contractor Registration Form Fill In (Village of Whitehouse)

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Completed 17 July 2020

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