Contractor License Application

< Contractor License Application

* Required Fields

License Information

Building Contractor License:

Skilled Trade License:

Roofing Contractor License:

Limited License:

Limited Description:

Other Licenses:

Business Information

*Business Name:

*Business Address:

*Business City, State, Zip:

*Business Phone:

Business Fax Number:

Email Address:

*Resident Supervisor's Name:

*Address:

*City, State, Zip:

*Phone:

General Information

*1. Has the business or any member of the firm ever held a contractor’s license or been a member of a firm so licensed in the City of Great Bend?:

If yes, state name and address of licensee, type of license held and periods covered.:

*2. State in detail (or attach) education information, construction qualifications, and experience of each member of the firm, as well as, the resident supervisor to be in charge of work::

*3. State name, address and phone number of three job references associated with the respective trade being applied for along with the job description::

Insurance Information

Certificate of Insurance and Surety Bond – All licenses require current certificate of insurance on file at all times except Class H House Mover. (Information sheet available.) City of Great Bend surety bonds are required for Class G Demolition Contractor and Class H House Mover.

*Certificate of Issuance:

*Issued By:

*Policy No.:

Surety Bond:

Issued By:

Bond No.:

Trades - Master Information

Certificate Required: Certificates are required for all employees working for an electrical contractor, a mechanical contractor, plumbing contractor, gasfitting contractor, and water treating contractor, as well as, uncertified employers. Each employee is to complete a certificate application. Certificate fees are additional to licensing, plan review, and permit fees. (Separate applications and information sheet available. Testing may be required.

Name of Certified Master:

Type of Certificate:

Expiration Date:

I do hereby certify that the information contained herein is true and correct.

*Name:

*Applicant Email Address:

Applications will be reviewed by Building Inspections. If additional information is needed, we will be in contact with you.

*Please Note: Submitting an application does not authorize work to begin. No work is to start until you have received an official contractor's license.

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