BUILDING DIVISION CONTRACTOR LICENSING DEPARTMENT 7722261230 FAX 7727705333 INDIAN RIVER COUNTY CITY OF VERO BEACH COMPETENCY CARD PROCEDURES STATE CERTIFIED APPLICANTS Complete Apprentice A ID: 840312
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__________________________________________ APPLICATION FOR REGISTRATION INDIAN RIVER COUNTY/CITY OF VERO BEACH STATE CERTIFIED CONTRACTOR BUILDING DIVISION CONTRACTOR LICENSING DEPARTMENT 772-226-1230 FAX #: 772-770-5333 INDIAN RIVER COUNTY/ CITY OF VERO BEACH COMPETENCY CARD PROCEDURES STATE CERTIFIED APPLICANTS: Complete Apprentice Application fully (Put N/A in boxes that do not apply)Submit copy of current Florida State Certification. Provide Certificate of Insurance for: General Liability Worker’s Compensation Made out to: Indian River County Building Department, 1801 27StreetVero Beach, FL 32960 Note: If you’re exempt from Worker’s Compensation Insurance, please provide proof of exemption. Submit copy of current business tax receipt/occupational license (municipality of business)Submit copy of qualifier’s valid Driver’s License. CERTIFIED THESE DOCUMENTS MAY BE MAILED, DELIVERED OR FAXED. IF FAXED, PAYMENT CAN BE MADE WITH CHARGE CARD. COMPLETE FORM: http://www.irccdd.com/Applications/Credit_Card/Application.pdf For further information, contact the Contractor License Department by email: contractorlicensing@ircgov.com BUILDING DIVISION CONTRACTOR LICENSING DEPARTMENT 772-226-1230FAX #: 772-770-5333 INDIAN RIVER COUNTY/ CITY OF V BEREGISTRATION PROCEDURESSTATE CERTIFIED APPLICANTS: Made out to: Indian River County Building Department, 1801 27StreetVero Beach, FL 32960 Note: If you’re exempt from Worker’s Compensation Insurance, please provide proof of exemption. Submit copy of current business tax receipt/occupational license (municipality of business)Submit copy of qualifier’s valid Driver’s License.CERTIFIED THESE DOCUMENTS MAY BE MAILED, DELIVERED OR FAXED. IF FAXED, PAYMENT CAN BE MADE WITH CHARGE CARD. COMPLETE FORM: http://www.irccdd.com/Applications/Credit_Card/Application.pdf For further information, contact the Contractor License Department by email: contractorlicensing@ircgov.com Complete Application fully (Put N/A in boxes that do not apply)Submit copy of current Florida State Certification.Provide Certificate of Insurance for:General LiabilityWorker’s Compensation __________________________________________ APPLICATION FOR REGISTRATION INDIAN RIVER COUNTY/CITY OF VERO BEACH STATE CERTIFIED CONTRACTOR DATE: _______________________________TYPE OF CONTRACTOR: _____________________
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_________________________________ BUSINESS NAME: ___________________________________________________________ QUALIFIER NAME: ____________________________________________________________ MAILING ADDRESS: _________________________________________________________ PHYSICAL ADDRESS: _________________________________________________________ QUALIFIER DRIVER’S LICENSE STATE: ____________ DL #: ________________________ QUALIFIER D.O.B._________ BUSINESS EMAIL: _________________________________ BUSINESS PHONE: _____________________ USINESS FAX: ________________________ BUSINESS MOBILE: _______________________The following is REQUIRED to be submitted with this application in order for us to process the application. Incomplete Applicationwill not be processedCopy of State CertificateCopy of Business Tax Receipt/Occupational LicenseCertificate of Insurance forGeneral Liability Worker’s Compensation or State of Florida Worker’s Compensation Exemption Certification. Certificate Holder: Indian River County Building Department, 801 27Street, Vero Beach, FL 32960 Copy of Qualifiers Valid Drivers LicenseI hereby agree to keep the required insurance in force, and to procure a City of Vero Beach or IndiaRiver County Local Business Tax Receipt (Occupational Licenseprior to opening a place of business within these jurisdictions. QUALIFIERS SIGNATURE QUALIFIERPRINTNAME STATE OF FLORIDA, COUNTY OF INDIAN RIVER: The foregoing instrument was acknowledged before me this ________ day of _________________, 20 __________, by _________________________ who: ___ is personally known by me OR produced I. D./ Type _______________________ SEAL: NOTARY PUBLIC INDIAN RIVER COUNTY/ CITY OF V BEREGISTRATION PROCEDURESSTATE CERTIFIED APPLICANTS: Made out to: Indian River County Building Department, 1801 27StreetVero Beach, FL 32960 Note: If you’re exempt from Worker’s Compensation Insurance, please provide proof of exemption. Submit copy of current business tax receipt/occupational license (municipality of business)Submit copy of qualifier’s valid Driver’s License.CERTIFIED THESE DOCUMENTS MAY BE MAILED, DELIVERED OR FAXED. IF FAXED, PAYMENT CAN BE MADE WITH CHARGE CARD. COMPLETE FORM: http://www.irccdd.com/Applications/Credit_Card/Application.pdf For further information, contact the Contractor License Department by email: contractorlicensing@ircgov.com Complete Application fully (Put N/A in boxes that do not apply)Submit copy of current Florida State Certification.Provide Certificate of Insurance for:General LiabilityWorker’s Compensatio