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Contractor Registration Requirements & Application Form Village of Plainfield 14400 Coil Plus Dr , Plainfield, IL 60544 Phone (815) 43 9 -2937, Fax (815) 609 -6114 3/1/2013 CONTRACTOR REGISTRATION APPLICATION BUSINESS INFORMATION : Date:____________________ NAME OF BUSINESS: ____________________________________________________________________________ ADDRESS (PO BOX’S ARE NOT ACCEPTED ):______________________________________________________ CITY: ______________________________________ STATE: __________________ ZIP: ___________________ BUSINESS PHONE: __________________________ FAX: _______________________________ TYPE OF BUSINESS (i.e. concrete, electrical, carpentry): ________________________________ REGISTERING AS A: GENERAL SUB -CONTRACTOR Name of primary contact : ________________________________Email:____________________________________ Is the C ontractor registration for a COMMERCIAL project? Yes No 24 H OUR EMERGENCY PHONE NUMBER (REQUIRED): ____________________________ GENERAL CONTRACTORS: Are required to submit the application , pay $50 annual registration fee , provide a SIGNED, SU RETY BOND in the amount of $1 0,000 and CERTIFICATE OF INSURANCE for General Liability in the amount of $1,0 00,000 listing the Village of Plainfield as certificate holder . SUB -CONTRACTORS: Are required to submit the application and pay $50 annual regi stration fee . ELECTRICAL CONTRACTORS : Are required to submit the application , pay $50 annual registration fee , CERTIFICATE OF INSURANCE for General Liability in the amount of $1,0 00,000 listing the Village of Plainfield as certificate holder and a cop y of current Illinois electrical license where electric test was taken. PLUMBING and IRRIGATION CONTRACTORS: Are required to submit the application , NO FEE , and provide a copy of the Illinois Health Certificate in the business name and the Owner's Journeyman’s card or Illinois Health Certificate and/or Irrigation certificate . ROOFING/SIDING CONTRACTORS: All roofing & siding contractors who are acting as Generals , are required to submit the application , pay $50 annual registrati on fee , provide a SIGNED, SURETY BOND in the amount of $1 0,000 and CERTIFICATE OF INSURANCE for General Liability in the amount of $1,0 00,000 listing the Village of Plainfield as certificate holder . Roofers must provide a current copy of State of Illinoi s Roofing License. All contractors must submit an updated Contractor registration form yearly. Signature: _________________________________ ANNUAL FEE: $50.00 is non -refundable ----------------------------------------------FOR OFFICE USE ONLY ------------------------------------------------- Registration No . ______________ Issued By: _______________ Date Issued: _____________________