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Contractor Registration Form

2. Contractor Registration Form
   Registration Fee of $100

   Registration Fee of $100

4. Company Name*

6. Business Address1*

8. Business Address2

10. City*

11. State*

12. Zip*

14. First & Last Name of Owner / Principal*

16. Address1 of Owner / Principal

    Only required if different than the address above

18. Address2 of Owner / Principal

20. City

21. State

22. Zip

24. Business Telephone*

25. Company Email*

27. I hereby certify:*

    1. I am familiar with all City of Waukegan Ordinance, Current Adopted Codes, and Amendments
    2. I have sufficient experience to be a contractor. I will complete all work in a workmanlike manner. I will conduct myself professionally when dealing with City personnel, Citizens and business owners
    3. I will call for inspections as required (before covering any work) 24 to 48 hours ahead of time by emailing to permits@waukeganil.gov
    4. I have received a list of current codes and required inspections (list can be found on Building Page)
    5. I will hold the City of Waukegan harmless of any and all situations that may occur while construction is being done.

29. Insurance Certificate Required for the following:
    <ol><li>Comprehensive Liability, General Aggregate $2,000,000 min limits</li><li>Proof of Worker's Compensation </li><li>Proof of Automotive Liability <li>City of Waukegan, as additional insured</li></ol>

    1. Comprehensive Liability, General Aggregate $2,000,000 min limits
    2. Proof of Worker's Compensation
    3. Proof of Automotive Liability
    4. City of Waukegan, as additional insured

31. Demolition

    1. $100.00 Annual Registration Fee
    2. COI (Certificate of Insurance)
    3. $15,000 License and Permit Bond

32. Electrical Waukegan Licensed

    1. $300.00 Three (3) year license
    2. COI (Certificate of Insurance)
    3. $10,000 License and Permit Bond
    4. Approved Waukegan Test Results

33. Electrical Licensed in Illinois

    1. $100.00 Annual Registration Fee
    2. COI (Certificate of Insurance)
    3. $10,000 License and Permit Bond
    4. Copy of Illinois Municipality License

35. Elevator

    1. $100.00 Annual Registration Fee
    2. COI (Certificate of Insurance)
    3. Copy of Illinois State License

36. Excavator

    1. $100.00 Annual Registration Fee
    2. COI (Certificate of Insurance)
    3. $15,000 License and Permit Bond

37. General Contractor

    1. $100.00 Annual Registration Fee
    2. COI (Certificate of Insurance)

39. HVAC

    1. $100.00 Annual Registration Fee
    2. COI (Certificate of Insurance)
    3. Copy of EPA License Card

40. Plumber

    1. Copy of Illinois 058
    2. Copy of Illinois 055
    3. Authorization Letter from License Holder (if employees will be pulling permits)

41. Roofer

    1. $100.00 Annual Registration Fee
    2. COI (Certificate of Insurance)
    3. Copy of Illinois State License
    4. Authorization Letter from License Holder (if employees will be pulling permits)

43. Sign Erector

    1. $100.00 Annual Registration Fee
    2. COI (Certificate of Insurance)
    3. $10,000 License and Permit Bond (if sign includes electric)
    4. Copy of Illinois Municipality Electrical License (if sign includes electrical)

44. Wireless Provider

    1. $100.00 Annual Registration Fee
    2. COI (Certificate of Insurance)
    3. $15,000 License and Permit Bond

46. Upload Proof of Insurance*

    To upload multiple files, please hold the "CTRL" key when selecting files

48. License and Permit Bond

    To upload multiple files, please hold the "CTRL" key when selecting files

50. Copy of Trade License

    To upload multiple files, please hold the "CTRL" key when selecting files

52. Additional License / State of Illinois

    To upload multiple files, please hold the "CTRL" key when selecting files

54. Authorization Letter or Other Document

56. Electronic Signature*

    By clicking on 'Electronically Sign' below, you understand that an electronic signature is taking place and you intend to be bound by and authenticate this electronic record and attest to the statements contained within, and that you understand that submitting another individual's electronic signature or attesting to false statements in an electronic record is a false statement that is punishable as unsworn falsification under AS 11.56.210; is an offering of a false instrument for recording that is punishable under AS 11.46.550; and may constitute other crimes such as perjury, theft, attempted theft, criminal mischief, forgery, criminal impersonation, scheme to defraud or criminal use of a computer; or other criminal offenses under state, municipal, or federal law.

    1. Electronically Sign
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit Submit and Print

* indicates a required field