Fillable New.crapp2 3 New Application/ Renewal Form (Office of the Chief Information Officer)

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New.crapp2 3 New Application/ Renewal Form (Office of the Chief Information Officer)

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Iowa Division of Labor
Contractor Registration
150 Des Moines Street
Des Moines, IA 50309-1836
Phone: 515-242-5871
Fax: 515-725-2427
contractor.registration@iwd.iowa.gov
www.iowacontractor.gov
All “construction” contractors doing business in
Iowa and making more than $2,000.00 per year
must be registered with the Iowa Division of Labor.
“Construction” is defined very broadly to include
companies or individuals who perform electrical,
plumbing, roofing, house painting, installation of
landscaping, windows, cable, elevators and many
other activities.
Plumbing, HVAC/R, Hydronics, and Mechanical Professionals
If you require a license with the Plumbers & Mechanicals Systems Board (PMSB), do not complete this form. Instead please
visit www.idph.iowa.gov/pmsb or call 866-280-1521 to complete registration and licensing together.
Fee Exemption
Self-employed contractors who meet the specific criteria may send a completed signed and notarized Fee Exemption
form instead of payment. To qualify for registering without payment, a self-employed contractor must not work with or for
other contractors in the same phases of construction and must not pay more than $2,000.00 per year to employ others.
NAICS code
The North American Industry Classification System (NAICS) is used by Federal statistical agencies to classify businesses for
statistical purposes. The application requires the NAICS code that applies to your business activity. Choose from the list of
NAICS codes below.
230000
Other/Undefined
237310
238220
Plumbing/Heating & A/C Contractors
236115
New Single-Family Housing Construction
237990
238290
Other Building Equipment Contractors
236116
New Multifamily Housing Construction
238110
238310
Drywall & Insulation Contractors
236117
New Housing For-Sale Builders
238120
238320
Painting & Wall Covering Contractors
236118
Residential Remodelers
238130
238330
Flooring Contractors
236210
Industrial Building Construction
238140
238340
Tile/Terrazzo Contractors
236220
Commercial & Institutional Bldg Construction
238150
238350
Finish Carpentry Contractors
237110
Water/Sewer Line Construction
238160
238390
Other Building Finishing Contractors
237120
Oil/Gas Pipeline Construction
238170
238910
Site Preparation Contractors
237130
Power/Communication Line Construction
238190
238990
All Other Specialty Trade Contractors
237210
Land Subdivision
238210
Out-of-State Contractors
Out-of-state contractors must file a $25,000.00 surety bond at the time of registration. The bond must meet three criteria in
order to be valid: 1) the bond must be executed by a surety company licensed to do business in Iowa, 2) the bond must be
issued on the Out-of-State Bond form provided at www.iowacontractor.gov with the bonding company's seal and two original
signatures, and 3) the bonding company must attach their Power of Attorney (POA) to the form. Once we have accepted a
valid bond, we consider it continuous until we receive a bond cancellation from the bonding company. If an out-of-state
contractor is pre-qualified to bid on projects for the Iowa Department of Transportation (DOT), they may submit their DOT-
issued pre-qualification letter in lieu of a bond.
Unemployment Insurance Number
You must obtain an unemployment insurance number before applying for contractor registration even if you have no
employees. To obtain a UI# visit www.myiowaui.org or contact customer service at 888-848-7442 or IWDuitax@iwd.iowa.gov.
Workers’ Compensation
A contractor with one or more employees must submit proof of workers’ compensation insurance. In most cases employers
must submit a certificate of insurance showing an effective date and listing the Division of Labor as a certificate holder. A
self-insured contractor shall submit a Certificate of Relief from the Iowa Insurance Division.
Online Public Portal
You may pay for your annual $50.00 non-refundable registration fee and submit your renewal/application online at
https://contractor.iowa.gov. Unless you already have an account to do electronic business with the State of Iowa, you will be
required to create an Authentication & Authorization account. More information can be found at www.iowacontractor.gov.
Submit a $50.00 non-refundable registration fee by check or money order payable to “Iowa Division of Labor,” a completed
application and any required attachments. An incomplete form or missing attachments will delay the registration process. All
contractors are required by Iowa Code 91C to renew yearly.
Your application cannot be processed until the following have been completed:
Signed and completed new application/renewal form
Valid unemployment insurance account number - create an account at www.myiowaui.org
NAICS code (business activity)
$50.00 non-refundable check/money order or signed and notarized Fee Exemption form
Workers’ Compensation box checked and required documents attached (if applicable)
Out-of-State Contractor Bond form with POA attached or letter from the DOT (if applicable) on file (renewals do not
need to complete this step, bonds are considered continuous until a cancellation notice is received)
Equal Opportunity Employer/Program
Auxiliary aids and services are available upon request to individuals with disabilities.
For deaf and hard of hearing, use Relay 711.
500-001
01.13.2020
21.GFee Exemption
I do not qualify I believe I qualify (fee exemption form must be completed, signed and notarized)
22.GWorkers’ Compensation – Check ONE that applies to your business
I am insured – enclose copy of Workers’ Compensation Insurance certificate listing the Iowa Division of Labor as a certificate holder
I am self-insured – enclose copy of Certificate of Relief issued by the Iowa Insurance Division
I have no employees
23.GOut-of-State Contractor
I am not an out of state contractor I am an out-of-state contractor (attach Out-of-State Contractor Bond form with POA or letter from the DOT, if applicable)
Name of individual completing form Signature Date
24.GI certify that the information on this form and the attachments is true and accurate to the best of my knowledge.
Contractor Registration
Application/Renewal Form
Supplying false information with a contractor registration application may result in a $500.00 civil penalty and criminal prosecution.
1.GOwner/officer name
2.GBusiness name
3.GDoing Business As (if you have registered with the Secretary of State as a DBA only)
4.GPrevious contractor registration #
5.GPhone number
6.GMobile number
7.GFax number
8.GEmail address
9.GAddress
10.GCity
11.GState
12.GZip
13.GCounty
14.GOwner’s social security #
15.GBusiness FEIN#
16.GNAICS code #
17.
. New application
. Renewal
18.GUnemployment Insurance #
19.GBusiness type: Corporation Partnership Sole Proprietor
. Trustee Other (i.e. LLC):
20.GName of additional owner, officer, partner or member
Email address
Phone number
Mailing address
City
State
Zip
Name of additional owner, officer, partner or member (use additional paper if needed)
Email address
Phone number
Mailing address
City
State
Zip
Iowa Division of Labor
Contractor Registration
150 Des Moines Street
Des Moines, IA 50309-1836
Phone: 515-242-5871
Fax: 515-725-2427
contractor.registration@iwd.iowa.gov
www.iowacontractor.gov
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New.crapp2 3 New Application Renewal Form (Office of the Chief Information Officer)

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Completed 13 August 2020

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