Fillable ELC003 Electrical- Electrical Sign Contractor License Application (U.S. State of Texas)

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ELC003 Electrical- Electrical Sign Contractor License Application (U.S. State of Texas)

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The ELC003 Electrical- Electrical Sign Contractor License Application (U.S. State of Texas) form is 4 pages long and contains:

  • 2 signatures
  • 13 check-boxes
  • 16 other fields

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File type: PDF

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TDLR Form ELC003 rev September 2019
ELECTRICAL OR ELECTRICAL SIGN CONTRACTOR LICENSE APPLICATION INSTRUCTIONS
DOCUMENTS SUBMITTED WITH YOUR APPLICATION WILL NOT BE RETURNED. KEEP A COPY OF YOUR
COMPLETED APPLICATION, ALL ATTACHMENTS, AND YOUR CHECK OR MONEY ORDER.
CHECKS OR MONEY ORDERS PAYABLE TO TDLR
1. LICENSE TYPE - Check the license type you are applying for.
2. BUSINESS NAME - Write the full name of your business as it will appear on your license. (40 characters maximum).
• If there is more than one business name, an assumed name certificate is required. If your business
is incorporated, contact the Texas Secretary of State’s office for a certificate. If your business is not
incorporated, contact your local county clerk’s office. NOTE: The certificates are not required by
TDLR. This is only required for your records.
• List the full assumed names or DBA’s for this business on the certificate of liability Insurance form.
The name/assumed business name on the certificate of liability must match the name on the
application.
• Assumed names will NOT print on the actual license.
• All business names will be listed on the TDLR website.
3. FEDERAL ID NUMBER - Write the federal ID number that is used by your business. Information about Federal or
Employer ID numbers can be found at: www.irs.gov/businesses.
4. TYPE OF OWNERSHIP - Check the box that shows how your business is organized.
5. MAILING ADDRESS - Write your current business mailing address. This is the address where we can send you mail.
A post office box can be used. You can add the zip plus-4 to help the postal service deliver mail more efficiently and
accurately.
6. PHYSICAL ADDRESS - Write the physical address (location) of your business. Do not use a post office box.
7. PHONE NUMBER - Write a telephone number, including the area code where we can reach you during the day or
where we can leave you a message.
8. EMAIL ADDRESS - Write your email address. By providing my email address I authorize TDLR to send licensing
communications and required notices to me by electronic mail. I understand that I may revoke this authorization in
writing and that I must update my email address, or I will not receive these notices. I understand that the email
address I have provided in this application will remain confidential except as permitted or required by law.
9. POINT OF CONTACT - Write the contact information of a person we can contact about your business. See item 8 for
email address disclosure information.
10. GENERAL LIABILITY INSURANCE - You must attach proof that your business has the minimum liability insurance
required by law and rule. A certificate of insurance must be attached to your application. Electrical contractors are
required to have at least the minimum general liability insurance coverage at all times to satisfy proof of financial
responsibility. The insurance must:
• be at least $300,000 per occurrence (combined for property damage and bodily injury);
• be at least $600,000 aggregate (total amount the policy will pay for property damage and bodily injury); and
• be at least $300,000 aggregate for products and completed operations.
Proof of your general liability insurance may be submitted on an industry standard certificate of insurance form with a
30-day cancellation notice. Insurance must be obtained from an admitted company or an eligible surplus lines carrier,
as defined in the Texas Insurance Code, Article 1.14-2, or other insurance companies that are rated by A.M. Best
Company as B+ or higher.
TDLR Form ELC003 rev September 2019
11. WORKERS’ COMPENSATION INSURANCE - Check the box that identifies how you have satisfied the Workers’
Compensation Insurance requirement.
• I have workers’ compensation insurance: Proof of workers’ compensation insurance can be submitted on
an industry standard certificate of insurance form with a 30-day cancellation notice. Insurance must be
obtained from an admitted company or an eligible surplus lines carrier, as defined in the Texas Insurance
Code, Arti- cle 1.14-2, or other insurance companies that are rated by A.M. Best Company as B+ or higher.
• I have self-insurance: The Self-Insurance program administered through the Texas Department of
Insurance, Division of Workers’ Compensation (DCW) is limited to larger-size employers. Employers must
show a manual premium of at least $500,000 in Texas or $10,000,000 nationally, post a minimum-security
deposit of $300,0000, in addition to other substantive requirements in order to be approved as a Certified
Self- Insurer. Generally, companies with less than 200 employees will not meet the above criteria.
For more information or to request an initial application packet, contact Division of Workers’ Compensation
S
elf-insurance Regulation by calling (512) 804-4345 or faxing (512) 804-4346 during normal business hours
of 8:00 a.m. to 5:00 p.m. Monday through Friday CST.
Se
lf-Insurance Regulation
Texas Department of Insurance
Division of Workers’ Compensation
7551 Metro Center Drive Suite 100, MS-96
Austin, Texas 78744-1609
• I do not have workers’ compensation insurance: Subchapter A, Chapter 406, Labor Code and the rules of
the Texas Department of Insurance provide for employers to not have workers’ compensation insurance. An
Employer Notice of No Coverage or Termination of Coverage Form (DWC Form-005) is filed and can be
obtained by calling TDI/DWC forms management at (512) 804-4990. The form and related instructions ca
n
be d
ownloaded at:
www.tdi.texas.gov/forms/form20numeric.html. Contact TDI/DWC at (800) 372-7713 or (512)
804-4000 for additional information.
12. TEXAS MASTER ELECTRICIAN/MASTER SIGN ELECTRICIAN ASSIGNED TO THIS CONTRACTOR - This sec-
tion must be completed by the master electrician or master sign electrician.
∗ An Electrical Contractor can ONLY have a master electrician assigned to the electrical contractor.
• An applicant for an electrical contractor license must be:
♦ licensed in Texas as a master electrician or
♦ employs a person licensed in Texas as a master electrician.
∗ An Electrical Sign Contractor can have EITHER a master electrician or master sign electrician assigned to the
electrical sign contractor.
• An applicant for an electrical sign contractor license must be:
♦ licensed in Texas as a master electrician or master sign electrician or
♦ employs a person licensed in Texas as a master electrician or master sign electrician.
∗ Do you own more that 50 percent of this contracting business? - Check YES or NO to this question.
• A person who holds a Texas master electrician or master sign electrician license can only be assigned to a
single electrical contractor, unless the master electrician owns more than 50 percent of the electrical con-
tracting business.
∗ Name, license number, date, and signature of master electrician/master sign electrician - Sign this section, print
your name and license number as it appears on your master electrician/master sign electrician license issued by
TDLR.
13. STATEMENT OF OWNER - Carefully read the statement before signing and dating your application. This section
can be completed by an officer of the business.
2. Business Name: (as it will appear on your license, 40 character limit) See instruction sheet for more information
______________________________________________________________________________________________
3. Federal ID Number: S
ee instruction sheet
________________________________________
Page 1 of 2
TDLR Form ELC003 rev September 2019
ELECTRICAL OR ELECTRICAL SIGN CONTRACTOR LICENSE APPLICATION
YOU MUST MEET ALL REQUIREMENTS WITHIN TWELVE MONTHS OF THE FILING DATE, OR THE APPLICATION WILL BE TERMINATED.
APPLICATION FEE: $110 (FEE IS NON-REFUNDABLE)
ELECTRICAL CONTRACTOR
ELECTRICAL SIGN CONTRACTOR
1. License Type:
Number, Street Name, Suite Number/Apartment Number
City, State, Zip Code
5. Mailing Address: (PO box can be used for this address)
8. Email Address:
7. Phone Number:
_______________________________
(Area Code) Phone Number
Email address (ex: johndoe@gmail.com) (See Instruction sheet for disclosure information)
Number, Street Name, Suite Number/Apartment Number
City, State, Zip Code
6. Physical Address: (PO box cannot be used for this address)
9. Point of Contact:
_______________________________________________________________________________________________
Last, First Name, Middle Initial, Suffix (JR, SR, III)
___________________________________________
(Area Code) Phone Number
_________________________________________________________________________
Email Address (Ex: johndoe@gmail.com) See instructions sheet for disclosure information
Sole Proprietorship Corporation Limited Partnership
Limited Liability Company Limited Liability Partnership General Partnership
4. T
y
pe of Ow
n
e
rs
hip:
OR
A separate application must be completed for EACH separate license type.
DO NOT WRITE ABOVE THIS LINE
10. General Liability Insurance:
Electrical contractors are required to satisfy proof of financial responsibility by maintaining general liability insurance
coverage as stated below:
(a) at least $300,000 per occurrence (combined for property damage and bodily injury);
(b) at least $600,000 aggregate (total amount the policy will pay for property damage and bodily
injury coverage);
(c) at least $300,000 aggregate for products and completed operations.
A certificate of insurance must be attached to your applicatio
n. The name/assumed business name on the certificate of
liability insurance must match the business name on your application. See instructions sheet for more information.
THIS SECTION MUST BE COMPLETED BY A MASTER ELECTRICIAN OR MASTER SIGN ELECTRIC
IAN
Do you own more than 50 percent of this electrical/electrical sign contractor business?
 An Electrical Contractor can ONLY have a master el
ectrician assigned to the electrical contractor.
An applicant for an electrical contractor license must be:
 licensed in Texas as a master electrician or
 employs a person licensed in Texas as a master electrician.
 An Electrical Sign Contractor can have EITHER a master electri
cian or master sign electrician assigned to the
electrical sign contractor.
An applicant for an electrical sign contractor license must be:
 licensed in Texas as a master electrician or master sign electrician or
 employs a person licensed in Texas as a master electrician or master sign electrician.
I agree to assign my license to this contractor and certify that I will comply with all applicable provisions of Texas Electri-
cal Safety and Licensing Act; Texas Occupations Code, Chapter 1305 and Chapter 51; Texas Administrative Code,
Chapter 60; and the Electricians Administrative Rules, Texas Administrative Code, Chapter 73. I understand that provid-
ing false information on this application may result in the revocation of my electrician license and this contractor license
and the imposition of administrative penalties.
________________________________ ____________________________________________________________
Assigned Electrician License Number
Print Name
________________________________ ____________________________________________________________
Date Signed
Assigned Electrician Signature
I have workers’ compensati
on insurance
I have self-insurance.
11. Workers’ Compensation Insurance: (Choose one of the following)
See instructions sheet for more infor
mation
I do not have workers’ compensation insurance
Yes No
I certify that I will maintain the required insurance and I will comply with all applicable provisions of Texas Electrical Safety and Licens-
ing Act; Texas Occupations Code, Chapter 1305 and Chapter 51; Texas Administrative Code, Chapter 60; and the Electricians Ad-
ministrative Rules, Texas Administrative Code, Chapter 73. I understand that providing false information on this application may result
in the revocation of the license I am requesting and the imposition of administrative penalties.
_______________________________________________________
Printed Name
________________________ _______________________________________________________
Date
Applicant Signature
Page 2 of 2
TDLR Form ELC003 rev September 2019
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ELC003 Electrical- Electrical Sign Contractor License Application (U.S. State of Texas)

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Completed 18 July 2020

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