Fillable Form 1.: SIGN CONTRACTOR REGISTRATION REQUIREMENTS (City of South Bend)

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Form 1.: SIGN CONTRACTOR REGISTRATION REQUIREMENTS (City of South Bend)

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SIGN CONTRACTOR REGISTRATION REQUIREMENTS
NEW CONTRACTORS
1.
Complete Contractor Pre-Licensing Registration form (see page 2)
2.
Provide Original Surety Bond as follows:
➢
Bond must have a bond number
➢
Term of bond must be for a one (1) year period with a beginning date and ending date
➢
Amount of bond must be $5,000
➢
Principal's nameon bond must match name used on registration
➢
Bond must name the City of South Bend/St. Joseph County as the obligee
➢
Bond form must indicate SIGN CONTRACTOR
➢
Original bond is required and must be signed
3.
Provide Certificate of Liability Insurance as follows:
➢
Certificate must name the City of South Bend/St. Joseph County as the Certificate Holder
➢
Limits of Liability must be $100,000 per person, $300,000 per occurrence, and $50,000 per property
damage
➢
Certificate must show proof of Workers Compensation (see details on page 2)
4.
Be properly registered with the State of Indiana, if applicable (http://www.in.gov/sos/business/2428.htm)
5.
$125 annual registration fee
RENEWALS
1.
Complete Contractor Pre-Licensing Registration form (see page 2)
2.
Provide Original Continuation Certificate of your Surety Bond
➢
If your Registration has been expired for more than 1 (one) year, you will be required to
provide the following:
o
Current Continuation Certificate of your Surety Bond
o ALL pr
evious Continuation Certificates
o ALL missed annual registration fees
*We cannot have a lapse in Bond coverage
➢
If providing a new bond instead of a Continuation Certificate, be sure to follow building
contractor registration requirements for new bond (above)
3.
Provide Certificate of Liability Insurance, following the guidelines above
4.
Continue proper registration with the State of Indiana, if applicable (http://www.in.gov/sos/business/2428.htm)
5.
$125.00 annual registration fee
ADDITIONAL INFORMATION REQUEST
As an ongoing effort to better serve the community, please take a minute to indicate if you are a member of one of the
groups listed on the following page. Please note that refusing or failing to self-identify into one of these categories cannot
be grounds to deny a registration request. Applications cannot be approved or denied on the basis of whether a
contractor’s business does or does not fall within one of these categories. (See questionnaire on page 3.)
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SIGN CONTRACTOR PRE-LICENSING REGISTRATION FORM
COMPANY NAME:
E-MAIL:
ADDRESS:
TELEPHONE NUMBER:
OFFICERS:
PRESIDENT/LICENSE HOLDER:
VICE PRESIDENT:
☐
Limited Liability Company (LLC)
☐
Sole Proprietorship
☐
General Partnership
☐
Corporation
☐
S-Corporation
☐
Nonprofit Corporation
☐
Limited Liability Partnership (LLP)
☐
Limited Partnership Other:
*All contractors must provide updated proof of workers’ compensation coverage in the form of:
• Certificate of Workers’ Compensation Insurance; OR
• Certificate of self-insurance from the Indiana Workers’ Compensation Board; OR
• Certificate of independent contractor exemption from the Indiana Department of Revenue
*If none of these documents apply, an affidavit or other legal basis for non-coverage in accordance with Indiana law
must be provided
*Contractors are responsible for having applicable Workers’ Compensation throughout Registration/License term.
https://www.in.gov/core/business_guide.html
*Contractors are responsible for being properly registered with the State of Indiana, when applicable:
http://www.in.gov/sos/business/2428.htm
I,
BEING DULY SWORN UNDER OATH, DEPOSE
and say that all the statements in this application herewithin are true. I will be responsible for compliance with all ordinances and laws in
effect governing work performed under building permits issued by the St. Joseph County/City of South Bend Building Department.
Signature of Applicant
Subscribed and Sworn to before me this
day of
Signature of Notary
My Commission Expires:
Resident of
County
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Minority‐Owned Business Enterprise (MBE):
“Minority-Owned Business Enterprise (MBE)” means a sole proprietorship, partnership, corporation, limited liability company, Joint Venture or any
other business or professional entity:
a) Which is at least 51% owned by one or more Minority Individuals, or in the case of a publicly owned business, at least 51% of all
classes of the stock of which is owned by one or more Minority Individuals; and
b) Whose management, policies, major decisions and daily business operations are independently managed and controlled by one or
more such more Minority Individuals;
Woman‐Owned Business Enterprise (WBE):
“Woman-Owned Business Enterprise (WBE)” means a sole proprietorship, partnership, corporation, limited liability company, Joint Venture or any other
business or professional entity:
a) Which is at least 51% owned by one or more Women, or in the case of a publicly owned business, at least 51% of all classes of the
stock of which is owned by one or more Women; and
b) Whose management, policies, major decisions and daily business operations are independently managed and controlled by one or
more such Women.
Veteran‐ Owned Business Enterprise (VBE):
“Veteran-Owned Business Enterprise (VBE)” means a sole proprietorship, partnership, corporation, limited liability company, Joint Venture or any other
business or professional entity:
a) Which is at least 51% owned by one or more Veteran, or in the case of a publicly owned business, at least 51% of all classes of the
stock of which is owned by one or more Veterans; and
b) Whose management, policies, major decisions and daily business operations are independently managed and controlled by one or
more such Veterans.
Small Business Enterprise (SBE):
Size standards vary by industry, and are generally based on the number of employees or the amount of annual receipts the business has. You can find
small business size regulations in Title 13 Part 121 of the Electronic Code of Federal Regulations (eCFR). https://www.sba.gov/size-standards/
Disadvantaged Business Enterprise (DBE):
“Disadvantaged Business Enterprise” means socially and economically disadvantaged individuals own at least a 51% interest and also control
management and daily business operations. African Americans, Hispanics, Native Americans, Asian-Pacific and Subcontinent Asian Americans, and
women are presumed to be socially and economically disadvantaged. Other individuals can also qualify as socially and economically disadvantaged on a
case-by-case basis.
Section 3 Business Enterprise (Sec3E):
“Section 3 Business Enterprise (Sec3E)” means a business that is at least 51% or more owned by Section 3 Residents,
A business where 30% of permanent, full-time employees are Section 3 residents or were Section 3 businesses.
A Section 3 Resident is:
a) A public housing resident or,
b) A low income person who lives in the metropolitan areas where a HUD-assisted project for housing or community
development is located. Low income is defined as income below 80% of the median household income of that area.
Disabled‐ Owned Business Enterprise (DOBE):
“Disabled Owned Business Enterprise” means a sole proprietorship, partnership, corporation, limited liability company, Joint Venture or any other
business or professional entity:
a) Which is at least 51% owned by one or more Disabled Individuals, or in the case of a publicly owned business, at least 51% of all
classes of the stock of which is owned by one or more Disabled Individuals; and
b) Whose management, policies, major decisions and daily business operations are independently managed and controlled by one or
more such Disabled Individuals.
Disabled Veteran‐ Owned Business Enterprise (DVBE):
“Disabled Veteran-Owned Business Enterprise (DVBE)” means a sole proprietorship, partnership, corporation, limited liability company, Joint Venture or
any other business or professional entity:
a) Which is at least 51% owned by one or more Disabled Veterans, or in the case of a publicly owned business, at least 51% of all
classes of the stock of which is owned by one or more Disabled Veterans; and
b) Whose management, policies, major decisions and daily business operations are independently managed and controlled by one or
more such Disabled Veterans.
LGBTE‐Owned Enterprise (LGBTE):
“Lesbian Gay Bisexual Transgender Business Enterprise” (LGBTE) means a sole proprietorship, partnership, corporation, limited liability company, Joint
Venture or any other business or professional entity:
a) Which is at least 51% owned by one or more LGBT individual, or in the case of a publicly owned business, at least 51% of all classes
of the stock of which is owned by one or more LGBT individuals; and
b) Whose management, policies, major decisions and daily business operations are independently managed and controlled by one or
more such LGBT individuals.
NONE APPLICABLE
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Form 1.: SIGN CONTRACTOR REGISTRATION REQUIREMENTS (City of South Bend)

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Completed 16 July 2020

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