Contractors Rater

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Contractor License #*

Name of Business*

Applicant Name*

E-Mail Address*

Phone Number*

Address*

City*

Zipcode*

Legal Structure*

Years In Business*

Classifications and Payroll (4 Max)

 

Carpentry (<$29/hr)

Carpentry (>=$29/hr)

Cabinet or Fixtures

Concrete or Cement Works - sidewalks (<$24/hr)

Concrete or Cement Works - sidewalks (>=$24/hr)

Wallboard Application (<$31/hr)

Wallboard Application (>=$31/hr)

Electrical Wiring (<$30/hr)

Electrical Wiring (>=$30/hr)

Fence Construction

Hardwood Floor Laying

Glaziers (<$29)

Glaziers (>=$29)

Ceiling Installation

Landscape Gardening

Lathing

Burglar Alarm Installation, Sevrice or Repair

Masonry (<$27/hr)

Masonry (>=$27/hr)

Painting, Decorating or Paper Hanging (<$24/hr)

Painting, Decorating or Paper Hanging (>=$24/hr)

Plumbing (<$26/hr)

Plumbing (>=$26/hr)

Sheet Metal Work (<$27/hr)

Sheet Metal Work (>=$27/hr)

Tile; Stone, Mosaic or Terrazzo Work



Number of Employees (Full Time) (Part Time)

Effective Date

Do you currently have insurance?

Have you had any previous claims in the last 5 years for Workers Compensation?

Ownership - (Additional Ownership is Optional)

Federal TAX ID Number or SSN (if Sole Prop)

Is your license currently active?

Do you have multiple locations?

Any Work Sublet without certificates of insurance?

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