TOWN OF RAMAPO
TOWN CLERK’S OFFICE -SEWER APPLICATION
CERTIFICATE OF REGISTRATION FOR PLUMBERS AND DRAIN LAYERS
Contact Information
Business Name:
Business Address:
Mailing Address:
Contact Person:
Phone #:
Alt. Phone #:
Email:
Fax #:
Rockland County License #:
Surety Bond & Insurance
Surety Bond (Min. Amt. $10.000):
Bond #:
Name of Bonding Company:
Public Liability Insurance ($50,000/$100,000):
Property Damage Insurance ($5,000):
Insurance Company Name:
Insurance Company Address:
Insurance Policy Number:
Workmen’s Compensation
YES
1
NO
2
1
If checked, attach certificate
2
If checked, complete and attach waiver form CE-200 as found on
http://www.wcb.state.us/content/main/forms
Personal References
Name
Address
$100 Application Fee is Non- Refundable
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