(c) If you are ling for a foreign corporation, is it registered to do business in New Jersey? Yes No
If “Yes,” please provide the date of registration in New Jersey. ________________________
Providethenamesofalloftheofcersand,inaddition,theownersof10%ormoreofthestock.
(d) President ______________________________________(g) Treasurer __________________________________________
(e) Vice-President __________________________________(h) Others ____________________________________________
(f) Secretary ______________________________________ ____________________________________________
9. Please enclose a bond. In addition to such other bonds as may otherwise be required, any person engaged in the business of electrical
contracting under the provisions of this act shall not undertake to do any electrical work in the State of New Jersey or any political
subdivision thereof unless and until he/she shall have entered into bond in favor of the State of New Jersey, in the sum of $1,000.00,
executed by a surety company authorized to transact business in the State of New Jersey approved by the Department of Banking and
Insurance, and to be conditioned on the faithful performance of the provisions of this act. The board shall, by rule and regulation,
provide who shall be eligible to receive the nancial protection afforded by said bond. The aforesaid bond shall be for the term of
36 months and must be renewed upon expiration for the ensuing 36 months. (Source: L. 1962, c. 162, § 19 as amended by L. 1962,
c. 185, §16.) (N.J.S.A. 45:5A-19.)
10. Please enclose a certicate of general liability insurance or a bank letter of credit. Every person who holds a Business Permit
for electrical work pursuant to P.L. 1962, c. 162 (C. 45:5A-1 et seq.) shall secure, maintain and le with the board a certicate of
general liability insurance in the minimum amount of $300,000 or a bank letter of credit in the minimum amount of $300,000.
Afdavit B (See Item 11 above)
Signed _____________________________________________________
Licensed Electrical Contractor
Sworn and subscribed to before me this ___________________________
day of __________________________, __________________________
___________________________________________________________
Name of Notary Public (please print)
___________________________________________________________
Signature of Notary Public
My commission expires ______________________________________
Afdavit A must be executed on every application.
12. The current triennial renewal period runs from April 1, 2018 through March 31, 2021. If this Business Permit application is
submitted in the rst year of the current triennial renewal period, the application fee is $150.00. If this application is submitted during
the second year of the triennial renewal period, the fee is $100.00, and if it is submitted in the third year of the triennial renewal period,
the fee is $50.00.
Please send a certied check, postal money order or express money order payable to the State of New Jersey and mail it to:
Board of Examiners of Electrical Contractors
P.O. Box 45006
Newark, NJ 07101
Corporation Seal (if any)
Notary's Seal
To Notary Public:
Please make sure
that the person
taking the oath has
read all of Item 11.
To Notary Public:
Please make sure
that the person
taking the oath has
read all of Item 11.
Notary's Seal
Afdavit
11. Afdavit A, below, must be executed by the owner, or a partner, as listed in Item 2 of this application or by a principal ofcer as
listed in Item 8 if the business is owned by a corporation. If the person executing Afdavit A is not also the Licensed Electrical
Contractor then, in addition, the Licensed Electrical Contractor must execute Afdavit B.
Each afdavit must be sworn to before a notary public or other authorized ofcer.
I do solemnly swear and afrm that the answers and statements made in this form are true and correct to the best of my knowledge
and belief.
Afdavit A (See Item 11 above)
___________________________________________________________
Name of Business (If a corporation, please give the exact legal title.)
___________________________________________________________
Signature of owner or ofcer (Check title below)
Owner Partner Trustee Receiver
Lessee Secretary Executor president
Sworn and subscribed to before me this ___________________________
day of __________________________, __________________________
___________________________________________________________
Name of Notary Public (please print)
___________________________________________________________
Signature of Notary Public
My commission expires ______________________________________
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