Contractor Licensing Section Form - State Of Alaska (Page 3 of 8) in pdf

BONDING REQUIREMENTS

Proof of a current bond must be attached to this renewal application. Applications received without proof of a current surety

bond OR certificate of cash deposit OR a state trust account are incomplete and will not be processed.

SURETY BOND - The bonding information you submit must be consistent with the information that is currently on file with the

Division. A copy of the original bond filed with the Division is not acceptable proof of a current bond. Contact your bonding

company for a continuation certificate or written verification that the bond is still in full force and in effect, or if you have been issued a

new bond at any time during the licensing period and did not submit it to the division at the time of issue, submit the new original signed

bond and power of attorney with this renewal application.

-OR-

CERTIFICATE OF CASH DEPOSIT (in lieu of a surety bond) - No information required if you have a certificate of cash deposit on

file with the Division.

-OR-

STATE TRUST ACCOUNT (in lieu of a surety bond) - No information required if you have a state trust account on file with the

Division.

GENERAL LIABILITY INSURANCE

You must submit a certificate or proof of insurance listing the insured exactly as licensed, name of the insurance provider, policy

number, commencement date and expiration date. A policy with “AOS” or “All other states” endorsement is not acceptable proof of

current coverage in the state. The certificate must state “covers activities in Alaska.” The certificate of insurance must be attached to

this general contractor renewal application.

WORKERS’ COMPENSATION INSURANCE

With Employees – If you have employees you must submit proof of Worker’s Compensation insurance. This certificate of insurance

must be attached to this general contractor renewal application. Submit a certificate of insurance issued by your provider listing the

insured exactly as licensed, name of the insurance provider, policy number, commencement date and expiration date.

No Employees – If you have no employees check the appropriate box:

My business is a:

Sole Proprietorship

Partnership

LLC

Corporation

Name:

Date:

Signature:



If you are a corporation, submit a copy of an Executive Officer Waiver or a Self Insurance Certificate

issued by the Alaska Board of Workers Compensation. Contact the Workers Compensation Board

at (907) 465-2790 for questions concerning a waiver or self insurance certificate.

08-4135

Rev. 12/17/14

Application page 3 of 4

Contractor Licensing Section Form - State Of Alaska Page 3