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 CONTRACTORS 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)
C
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.
R
ELEVANT
E
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
C
OMPLETE AND ATTACH ADDITIONAL
P
ART
3
S AS NECESSARY TO PROVIDE THE INFORMATION FOR ALL OF THE
F
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
M
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
C
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
M
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
C
ONSENT
Enter [Mobile Number]
12. I consent to receive notifications from the Registrar by text
messaging at the following telephone number
.....................................................
M
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
C
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
P
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?
If
‘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