Contractor License Application

Applicant Information

Applicant Name *

Address *

City *

State *

Zip *

Business Name of Applicant Holder: *

Phone # *

Cell #

Fax #

Email *

Verification of General Contractor License (test required) (check one)

Citizenship *

Class A

Class B

Class C

Have you or has your business ever had a contractor license revoked or suspended? *

Yes

If yes, please provide statement on where and why license was revoked or suspended.

List three (3) references of jobs completed:

Building Permit #

Address of Job

City

Owner’s Name

Permit1 *

Address1 *

City1 *

Owner1 *

Permit1 *

Address1 *

City1 *

Owner1 *

Permit1 *

Address1 *

City1 *

Owner1 *

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If in another jurisdiction other than Larimer County, must attach copies of the permit and Certificate of Occupancy or final inspection documentation for each job.

Proof of Jobs Completed (if applicable)

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Person(s) designated to apply for Building Permits on behalf of the licensed contractor:

Print Name

Signature

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signature

Print Name

Signature

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signature

(Attach separate sheet if more than two)

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I have read and agree to abide by the requirements contained in the contractor resolution. I understand that providing any incorrect or misleading information is grounds for denial of the license with no refund of any fees paid, and that incomplete applications or project forms will not be accepted. Further, I understand that achieving a passing score on a specific examination does is not sufficient approval for a particular license or certificate class without required documentation of experience.

Print Applicant Signature:

Signature of Applicant

Undo

signature

Date

CHECKLIST FOR ISSUANCE OF A GENERAL CONTRACTOR LICENSE

Pay nonrefundable contractor application fee. Need cash or check (we do not accept credit cards)
made out to Larimer County Planning for the amount of:
Class “A” License ($150) Class “B” License ($125) Class “C”License ($100)

Contractors must submit completed signed general contractor license application verifying
all contractor licenses held in other jurisdictions and if applicable disclosing any adverse action taken
under those licenses. List all business name(s) that your contractor license is doing business as for insurance
coverage purposes. Also submit all of the following required supporting documentations:

Provide proof of a passing grade on a current applicable license issued by another county
or municipality in the state of Colorado with a letter from that jurisdiction on their letterhead stating the
passing grade, type of license, year and model of code tested under. Or provide proof of a passing grade
on the applicable International Code Council (“ICC”) exam related to the particular license type being
applied for (or its nationally recognized equivalent as determined and approved by the Building Official).

Provide proof of three (3) successfully completed projects by listing three (3) construction projects
verified by building permit number on the applicant form and attach copies of the permit and
Certificate of Occupancy or final inspection documentation if in another jurisdiction.
Or have three (3) completed contractor project verification forms signed by the owners.
Or provide proof of two (2) years of experience in your license trade by submitting a letter
from previous employer verifying that experience.

Demonstrate a lawful presence in the United States by submitting a completed and signed
United States Citizenship Affidavit form that also certify as part of the license application process that
you or your company will employ only building subcontractors and workers who have demonstrated
to the company a lawful presence in the United States.
- A Driver’s License photocopy must also be submitted

Provide proof of current insurance coverage including

Provide proof of current insurance coverage, including:
1. Workers’ Compensation Insurance as required by the State of Colorado.
2. General Liability Insurance provided on an ISO 1998 (or most current) Form or equivalent form with
a minimum combined single limit for each occurrence of:
General Liability……………………………$300,000.00

Proof of such insurance shall be accompanied by a Certificate of Insurance issued to the County as a Certificate Holder requiring a ten (10) days notice for NON-PAYMENT OF PREMIUM, REDUCTION OF COVERAGE, OR CANCELLATION FOR ANY REASON and providing 30 days advance written notice to the Chief Building Official (at Larimer County Building Department, P.O. Box 1190, Fort Collins, CO 80522) signed by an authorized agent of the issuing company. In the event the required insurance is revoked, the contractor license is revoked upon such notice.

Instructions for Submitting Application

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1. Fill out this form (above)

2. Please attach:

Liability Insurance Certificate *

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Workers Compensation Certificate or WC Waiver Form *

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Proof of Passing Grade on the Applicable Exam *

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3.    Fill out United States Citizenship (below)

4.    Click Submit

5.    Go to Larimer County Online Portal and register as a user https://onlineportal.larimer.org

6.   Once your license has been processed, you will need to log in to the portal and pay the invoice.

7.   Once paid, final processing will take place and you will be issued a license.

Citizenship Information

UNITED STATES CITIZENSHIP AFFIDAVIT
Pursuant to Section 24-76.5-103(4)(b), C.R.S.

I swear or affirm under penalty of perjury under the laws of the State of Colorado that I am
(check one of the following)

Citizenship *

	A United States citizen; or
	A legal Permanent Resident of the United States; or
	Otherwise lawfully present in the United States pursuant to federal law.

I further swear I will employ only building contractors and workers who have demonstrated to the company a lawful presence in the United States.

I understand that this sworn statement is required by law because I have applied for a public benefit as defined by law. I understand that state law requires me to provide proof that I am lawfully present in the United States prior to receipt of this public benefit. I further acknowledge that making a false, fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the criminal laws of Colorado as perjury in the second degree under Colorado Revised Statute 18-8-503 and it shall constitute a separate criminal offence each time a public benefit is fraudulently received.

If I checked the second or third operation above, I understand that my lawful presence in the United States will be verified through the Federal Systematic Alien Verification of Entitlement Program (SAVE Program).

Printed Name

Signature

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signature

Company Name

Date

Fill out one of the means of identification and provide copy of your photo ID

U.S. Military I.D. Card #

Colorado Driver’s License #

Colorado Identification Card #

Native American Travel Document #

U.S. Coast Guard Merchant Marine Card #

Copy of Driver's License/Other ID *

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