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2. Contractor Registration Form
   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. Are you registering for the Community Development Block Grant Program (CDBG)?*
    -- Select One --YesNo

    If you select yes, your information will be sent to the CDBG Department. This information will ONLY start the process to get you added to their list and does NOT complete all requirements with their regulations.

31. 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
33. Demolition

    1. $100.00 Annual Registration Fee
    2. COI (Certificate of Insurance)
    3. $15,000 License and Permit Bond
34. 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
35. 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
37. Elevator

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

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

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

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

    1. Copy of Illinois 058
    2. Copy of Illinois 055
    3. Authorization Letter from License Holder (if employees will be pulling permits)
43. 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)
45. 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)
46. Wireless Provider

    1. $100.00 Annual Registration Fee
    2. COI (Certificate of Insurance)
    3. $15,000 License and Permit Bond
48. Upload Proof of Insurance*
    To upload multiple files, please hold the "CTRL" key when selecting files
50. License and Permit Bond
    To upload multiple files, please hold the "CTRL" key when selecting files
52. Copy of Trade License
    To upload multiple files, please hold the "CTRL" key when selecting files
54. Additional License / State of Illinois
    To upload multiple files, please hold the "CTRL" key when selecting files
56. Authorization Letter or Other Document
58. 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:


60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit Submit and Print

* indicates a required field