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Contractor Registration Form

  1. Contractor Registration Form

    Registration Fee of $100

  2. Only required if different than the address above

  3. I hereby certify:*

  4. Insurance Certificate Required for the following:

    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

  5. Demolition

  6. Electrical Waukegan Licensed

  7. Electrical Licensed in Illinois

  8. Elevator

  9. Excavator

  10. General Contractor

  11. HVAC

  12. Plumber

  13. Roofer

  14. Sign Erector

  15. Wireless Provider

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

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

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

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

  20. 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.

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