Fill - Free fillable LICENSE APPLICATION ARIZONA REGISTRAR OF CONTRACTORS (Arizona) PDF form

1700 W. Washington Street, Suite 105

●

Phoenix AZ 85007-2812

602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ● www.roc.az.gov

Form RC-L-200B

Rev.

July 30, 2021

License Application (LLC)

Instructions

ARIZONA REGISTRAR OF CONTRACTORS

Douglas A. Ducey, Governor

Jeff

Fleetham

Director

LICENSE APPLICATION

(Limited Liability Company)

THIS APPLICATION IS FOR LLCS ONLY

This License Application is for an LLC seeking to obtain an Arizona Contractor’s License.

You may submit this application through the online ROC portal by visiting the My Account section of

the roc.az.gov website.

STEPS TO OBTAIN A CONTRACTOR’S LICENSE

To obtain an Arizona Contractor’s License, complete the following:

Required Steps:

1) Form a legal entity: Register an LLC with the Arizona Corporation Commission. This

must be Active and In Good Standing and CANNOT be a name reservation.

2) Identify a Qualifying Party: The Applicant must identify a Qualifying Party for the

license. A Qualifying Party is a regularly employed person with the necessary

experience, knowledge and skills as defined under A.R.S. § 32-1122(E).

3) Pass Examination(s). The Qualifying Party must pass the required exams by at least

70% and submit exam results. The Qualifying Party must complete a statutes and rules

exam (SRE) and a specific trade exam, unless eligible for a waiver.

•To determine which exams are required for a specific license classification, refer to the

Registrar’s License Classification Requirements.

•The Qualifying Party can register to take the Statutes and Rules Exam through Mbition

and the Trade Exam through PSI Exams Online.

•For information about PSI’s testing procedures, refer to PSI's Candidate

Information Bulletin.

4) Government-Issued Identification. The Qualifying Party listed in Part 2, and each

individual listed in Part 3: Persons in this License Application must submit a copy of their government

issued identification with the application.

5) Submit to Background Checks. The Qualifying Party listed in Part 2, and each

individual listed in Part 3: Persons in this License Application must submit copies of the

payment transaction receipt from their background checks.

6) Bond. The Applicant must obtain and submit proof of a license Bond.

7) Signatures: Complete the signatures section in Part 6.

8) Fees: Pay the required application fee, licensing fee, and for dual or residential licenses, the

recovery fund assessment.

1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812

602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ● www.roc.az.gov

Form RC-L-200B

Rev.

July 30, 2021

License Application (LLC)

Instructions

Supplemental Documents

– Attach the following documents if applicable.

1. If the Applicant is a tiered entity, please see the example tiered entity chart and

contact the Registrar’s Licensing Department at (602) 542- 1525 for assistance

with questions. A Tiered Entity is an entity that is owned or operated by another entity. For

example, if "Red Corporation" is owned or operated by "Blue LLC," "Red Corporation" would be

considered a Tiered Entity for the purposes of obtaining a contractor's license.

2. License Cancellation Form: If you currently have a license that you wish to cancel upon

issuance of a new license, complete and attach a License Cancellation Form.

3. Felony Disclosure Forms. If 'yes' is selected for any of the Felony Charges questions

under Part 4, attach signed and completed Felony Disclosure Forms and supporting

documentation.

4. Unlicensed Activity Disclosure Forms: If 'yes' is selected for any of the Unlicensed

Activity questions under Part 4, attach signed and completed

Unlicensed Activity Disclosure Forms and documentation of remedial measures.

5. Solar Warranty: A copy of the solar warranty (if applying for a solar license)

6. Additional Part 3s: If there is insufficient space to enter all of the required information in

Part 3 of this application, print out, complete, and attach additional Part 3's to your application.

In State Waiver (Statutes &

Rules Exam)

The named Qualifying Party has

been active within the last 5 years

as Qualifying Party on an

existing Arizona license

Complete form In- State Waiver

Request for Statutes and Rules

Exam RC-L-200H in place of the

exam results for the Statutes and

Rules if applicable

In State Waiver (Statutes &

Rules Exam & Trade Exam)

The named Qualifying Party has been

active within the last 5 years on an

AZ License as Qualifying Party on

the same classification

Complete form In- State Waiver

Request for Statutes and Rules

Exam RC-L-200H and In- State

Waiver Request Form for Trade

Exam RC-L-200H in place of the

exam results for the Statutes and

Rules and Trade exam if applicable

Out of State Waiver (Trade

Exam):

The named Qualifying Party has

been active on a comparable out

of state license in the last 5 years

as the Qualifying Party

Complete form Out-of-State Waiver

Request form RC-L-200G in place of the

Trade exam if applicable. Note: The

Arizona Statute and Rules Exam cannot

be waived with an out of state waiver

Waivers

1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812

602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ● www.roc.az.gov

Form RC-L-200B

Rev. July 30, 2021

License Application

(LLC) Page 1 of 7

Form

RC-L-200B

LICENSE APPLICATION

(LLC)

For Internal Use Only

Pending #

PART 1: APPLICANT INFORMATION

To avoid delay or denial, the Applicant must completely and accurately fill out the following information.

•

The business address you provide will be publicly available on the Registrar’s website.

An applicant must provide an address or location of the applicant’s place of business, and a

mailing address if it is different from the applicant’s place of business. A.R.S. § 32-

1122(B)(1)(h).

•

To determine the appropriate License Classification Description in box 4, refer to the Registrar’s

License Classifications located at https://roc.az.gov/license-classifications.

1. Limited Liability Company Name 2. Optional DBA (Fictitious Trade Name)

3. Arizona Corporation Commission File Number

4. Requested License Classification Description

5. Business Address (No PO Boxes or Private Mail Boxes) City State Zip Code

6. Mailing Address (If different than business address) City State Zip Code

7. Phone Number 8. Email Address

9. Prior to completing this application, did you or any other member of your organization participate in or watch a video of the Registrar’s ‘Applicant

Education Seminar’?

(Yes) (No)

ONSENT

Enter [Mobile Number]

10. I consent to receive notifications from the Registrar by

text messaging at the following telephone number

....................

Workers’ Compensation Coverage

Applicants are required to be in compliance with the statutes and rules governing Workers’ Compensation coverage.

See A.R.S. § 32-1122(B)(1)(i). In general, if you have any employees, you must have Workers' Compensation

insurance. Please choose your Workers’ Compensation Coverage type from the list below:

1. Workers’

Compensation Insurance:

Policy Number

Company Issuing Policy

2. Self-Insured Employer (You Must Submit Documentation Showing Proof of Coverage with this Application)

3. If an LLC employs one or more employees, an LLC is required to obtain workers'

compensation insurance for those employees. In order to be exempt, the LLC must be a

single member or 50/50 with no employees. Is your company exempt from worker's

compensation requirements?

(YES)

(NO)

1700 W. Washington Street, Suite 105

●

Phoenix AZ 85007-2812

602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ● www.roc.az.gov

Form RC-L-200B

Rev. July 30, 2021

License Application (LLC)

Page 2 of 7

PART 2: QUALIFYING PARTY

QUALIFYING PARTY

The "Qualifying Party" is a person who has an ownership interest or is regularly employed by the Applicant and

is actively engaged in the classification of work for which the person qualifies on behalf of the Applicant. The

Qualifying Party must have the necessary experience, knowledge and skills to supervise or perform the

contracting work A.R.S. § 32-1101(A)(8).

1. Name as it appears on your government issued ID 2. Title/Position 3. Ownership %

4. Date of Birth (MM/DD/YYYY) 5. Driver’s License or Government ID No. 6. Social Security Number 7. Are you a U.S.

Citizen?

8. Residential Address City State Zip Code

9. Mailing Address (If different than residential address) City State Zip Code

10. Phone Number 11. Email Address

CONSENT

12. I consent to receive notifications from the Registrar

by text messaging at the following telephone number

13. Is the Qualifying Party currently active for another

entity in AZ?

Pursuant to A.R.S. § 32-1127(A) the Qualifying Party listed below may act as the Qualifying Party for

up to two licensees, but only when either:

1. There is a common ownership

of at least twenty-five percent of each licensed entity for which the

person acts in a qualifying capacity; or

2. One licensee is a subsidiary of another licensee for which the same person acts in a qualifying

capacity. "Subsidiary" as used in this section

means a corporation of which at least twenty-five

percent is owned by the other licensee.

ELEVANT

XPERIENCE

I am applying for the classification listed in Part 1 and listed below, and I attest to having the requisite knowledge

and experience dealing specifically with this type of construction, or its equivalent, as detailed on the roc.az.gov website. If

this is a dual license, please refer to both the commercial and residential components.

• Under A.R.S. § 32-1122(E)(1), at least two years of experience must be earned within the last ten years

1.I hold the requisite experience in the form of (Select all that apply):

Supervisor Hands On Military Education

2. Classification

3. Signature

Reference Section (Optional)

1. Optional Reference Name (If you would like you may provide a reference)

2. Reference Phone Number

3. Reference Email Address

1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812

602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ● www.roc.az.gov

Form RC-L-200B

Rev. July 30, 2021

License Application

(LLC) Page 3 of 7

PART 3: PERSONS

OMPLETE AND ATTACH ADDITIONAL

ART

S AS NECESSARY TO PROVIDE THE INFORMATION FOR ALL OF THE

OLLOWING

PERSONS ON THE LICENSE.

•

Owners of 25% or more of the stock or beneficial interest of the LLC.

•

If the Applicant is a Member-Managed LLC, then complete Part 3 for each Member.

•

If the Applicant is a Manager-Managed LLC, then complete Part 3 for each Manager.

This information is required under A.R.S. § 32-1122(B)(1)(d).

Every person listed on this application must be 18 years of age or older and must sign this application

form under Part 6: Signatures.

Arizona Corporation Commission Documents

To determine which individuals are members or managers of an LLC, refer to the

LLC’s entity documents. Entity documents can be located using the Corporation

Commission’s search tool located at http://ecorp.azcc.gov/Search.

•

If any corporation, LLC, partnership, trust, or other business organization

is listed on the applying entity’s Arizona Corporation Commission

documents, then please contact the Registrar’s Licensing Department at

(602) 542-1525 for assistance on completing the tiered entity organization

chart.

This application is for a:

Member-Managed LLC

Manager-Managed LLC

EMBER

/ M

ANAGER

All owners of 25% or more are required to provide the information below. All members on member-managed LLCs and all managers

on manager-managed LLCs at Arizona Corporation Commission are also required to complete the below.

1. Name as it appears on your government-Issued ID

2. Title/Position (“Member” or “Manager”) 3. Ownership % 4. Date of Birth (MM/DD/YYYY)

5. Identification No. (Driver’s License or Government ID No.) 6. Social Security Number 7. Are you a U.S. Citizen?

8. Business or Residential Address City State Zip Code

9. Mailing Address (If different than business or residential

address)

City State Zip Code

10. Phone Number 11. Email Address

ONSENT

Enter [Mobile Number]

12. I consent to receive notifications from the Registrar by text

messaging at the following telephone number

.....................................................

1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812

602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ● www.roc.az.gov

Form RC-L-200B

Rev.

July 30, 2021

License Application

(LLC) Page 4 of 7

EMBER

/ M

ANAGER

The Registrar requires all of the information below for each member (if the applicant is a member-managed

LLC) or each manager (if the applicant is a manager-managed LLC)

1. Name as it appears on your government-Issued ID

2. Title/Position (“Member” or “Manager”) 3. Ownership % 4. Date of Birth (MM/DD/YYYY)

5. Identification No. (Driver’s License or Government ID No.) 6. Social Security Number 7. Are you a U.S. Citizen?

8. Business or Residential Address City State Zip Code

9. Mailing Address (If different than business or residential

address)

City State Zip Code

10. Phone Number 11. Email Address

ONSENT

Enter [Mobile Number]

12. I consent to receive notifications from the Registrar by text

messaging at the following telephone number

.....................................................

EMBER

/ M

ANAGER

The Registrar requires all of the information below for each member (if the applicant is a member-managed

LLC) or each manager (if the applicant is a manager-managed LLC).

1. Name as it appears on your government-Issued ID

2. Title/Position (“Member” or “Manager”) 3. Ownership % 4. Date of Birth (MM/DD/YYYY)

5. Identification No. (Driver’s License or Government ID No.) 6. Social Security Number 7. Are you a U.S. Citizen?

8. Business or Residential Address City State Zip Code

9. Mailing Address (If different than business or residential

address)

City State Zip Code

10. Phone Number 11. Email Address

ONSENT

Enter [Email / Telephone]

12. I consent to receive notifications from the Registrar

by text messaging at the following telephone number

.......

1700 W. Washington Street, Suite 105

●

Phoenix AZ 85007-2812

602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ● www.roc.az.gov

Form RC-L-200B

Rev.

July 30, 2021

License Application

(LLC) Page 5 of 7

ART

4: D

ISCLOSURES:

Failure to accurately answer these questions may be a material

misrepresentation of fact and a violation of A.R.S. § 32-1154(A)(5)

•

PRIOR LICENSE INFORMATION

Circle

One

1. Has the Qualifying Party listed in Part 2 or any individual listed in Part 3 Persons

ever been named on a license in any state that was revoked or is currently

suspended?

(Yes) (No)

FELONY CHARGES

Answering ‘yes’ does not automatically disqualify the Applicant from receiving a

contractor’s license.

Circle One

2. Has the Qualifying Party listed in Part 2 or any individual listed in Part 3: Persons of this

application ever been convicted of a felony?

If ‘yes’ is selected, that person must complete

and attach the Felony Disclosure Form with this application.

(Yes) (No)

3. Does the Qualifying Party listed in Part 2 or any individual listed in Part 3: Persons of

this application have a pending felony charge that has not yet received a disposition?

‘yes’ is selected, that person must complete and attach

the Felony Disclosure Form

with this application.

(Yes) (No)

UNLICENSED ACTIVITY

Circle One

4. Has the Qualifying Party listed in Part 2 or any individual listed in Part 3: Persons of

this application ever received a citation for, or been convicted of, contracting without a

license in any state?

If ‘yes’ is selected, that person must complete and attach the

Unlicensed Activity Disclosure Form with this application.

(Yes) (No)

AGENCY DISCLOSURE

•

A.R.S. § 41-1030(B): An agency shall not base a licensing decision in whole or in part on a licensing

requirement or condition that is not specifically authorized by statute, rule or state tribal gaming compact. A

general grant of authority in statute does not constitute a basis for imposing a licensing requirement or

condition unless a rule is made pursuant to that general grant of authority that specifically authorizes the

requirement or condition.

•

A.R.S. § 41-1030(D): This section may be enforced in a private civil action and relief may be awarded

against the state. The court may award reasonable attorney fees, damages and all fees associated with the

license application to a party that prevails in an action against the state for a violation of this section.

•

A.R.S. § 41-1030(E): A state employee may not intentionally or knowingly violate this section. A violation of

this section is cause for disciplinary action or dismissal pursuant to the agency's adopted personnel policy.

•

A.R.S. § 41-1030(F): This section does not abrogate the immunity provided by § 12-820.01 or 12-

820.02.

1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812

602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ● www.roc.az.gov

Form RC-L-200B

Rev.

July 30, 2021

License Application

(LLC) Page 6 of 7



PART 5: REQUIRED DOCUMENTS

Before you submit your application, please review the following checklist. Missing

documents will delay the processing of your application.

Review the License Application and ensure that it contains the following:

Exam Results. The Qualifying Party’s original exam results, or a Completed Waiver Form.

Background Checks. Copies of the payment transaction receipt from the background check for every

individual named in Part 3: Persons and the Qualifying Party.

Bond. Completed original Bond Verification Form.

Fees. The required application fee, licensing fee and for dual or residential licenses also include

the recovery fund assessment

Government-Issued Identification. The Qualifying Party listed in Part 2, and each individual listed

in Part 3: Persons in this License Application must submit a legible copy of a government issued

photo identification with the application. Acceptable forms of identification include a valid driver’s

license or passport.

Signatures. Completed Signatures section (see next page).

SUPPLEMENTAL DOCUMENTS – Attach the following documents if necessary..

Additional Part 3s: If there is insufficient space to

enter all of the required information in Part 3

of this application, print out, complete, and attach additional Part 3s to your application.

License Cancellation Form. If you currently have a license that you wish to cancel upon the issuance

of a new license, complete and attach a License Cancellation Form.

Felony Disclosure Forms. If ‘yes’ is selected for any of the Felony Charges questions under, Part 4,

attach signed and completed Felony Disclosure Forms and supporting documentation.

Unlicensed Activity Disclosure Forms. If ‘yes’ is selected for any of the Unlicensed Activity

questions under Part 4, attach signed and completed Unlicensed Activity Disclosure Forms and

documentation of remedial measures.

Solar Warranty. A copy of the solar warranty (if applying for a solar license)

1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812

602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ● www.roc.az.gov

Form RC-L-200B

Rev.

July 30, 2021

License Application

(LLC) Page 7 of 7

PART 6: SIGNATURES

By signing below, each person certifies that the entire contents of this License Application Form, including

all supplementary statements and materials attached, are true and correct, and that this application is not

submitted with the intent to evade Chapter 10, Title 32 of the Arizona Revised Statutes.

A.R.S. § 32-1154(A)(9). It is a violation of A.R.S. § 32-1154(A)(5) to make a misrepresentation of a material

fact in obtaining a license.

Qualifying Party

The Qualifying Party listed under Part 2: Qualifying Party must sign this application below

_____________________ _____________________ ______________

Print Name Signature Date

Persons

Every person listed under Part 3: Persons must sign this application, even if they already signed above. If

you need additional space for signatures, complete and attach additional signature pages with your

application.

_____________________ _____________________ _____________________

Print Name Signature Date

_____________________ _____________________ _____________________

Print Name Signature Date

_____________________ _____________________ _____________________

Print Name Signature Date

_____________________ _____________________ _____________________

Print Name Signature Date

_____________________ _____________________ _____________________

Print Name Signature Date

LICENSE BOND

THIS BOND MUST BE ON FILE WITH THE ARIZONA REGISTRAR OF CONTRACTORS

STATE OF ARIZONA

REGISTRAR OF CONTRACTORS

BOND NO:

That

as the principal, and

(Surety)

a corporation, duly authorized and licensed to transact surety business in the State of Arizona, are held and firmly bound unto the State

of Arizona for the benefit of those persons described in A.R.S. §32-1152, as amended, in the penal sum set forth for the classification of

license described:

LICENSE CLASSIFICATION

PENAL SUM

The Principal has applied to the Registrar of Contractors of the State of Arizona for a license to conduct the business of contracting under

the above-described classifications and submits this bond to comply with the provisions of A.R.S. §32-1152, as amended, which are

incorporated herein as though fully set forth.

Liability under this bond is limited to the penal sum for each classification of work performed by the principal. Liability under each

classification shall be determined strictly in accordance with the provisions of A.R.S. §32-1152, as amended, which are incorporated

herein as though fully set forth.

Upon making payment to a claimant against the bond, the Surety shall immediately give written notice to the Principal and the Registrar

of Contractors of the date and amount of payment.

The amount of this bond is based on the representation of the Principal of the anticipated annual gross volume of work pursuant to Rule

R4-9-112.

This bond becomes effective on day of , 20 .

SIGNED, SEALED AND DATED day of , 20 .

By:

Signature of Contractor (Principal) Signature Attorney-In-Fact (Must be Notarized)

By:

Title of Signer Print or Type Name of Attorney-In-Fact

Subscribed and sworn to before me this

Print or Type Name of Contractor (Principal) day of , 20 .

Notary Public

My Commission Expires:

State of:

County of:

RC-L-220D 7/12

THE ORIGINAL BOND MUST BE SIGNED BY THE

PRINCIPAL, ATTORNEY-IN-FACT AND THE

NOTARY PUBLIC AND BE FILED WITH THE

REGISTRAR OF CONTRACTORS AT:

1700 W. Washington St. Ste. 105, PHOENIX, AZ

85007-2812, TO COMPLY WITH A.R.S. § 32-1152

Mail to: P.O. Box 6688, Phoenix, AZ 85005-6688

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