Form 500-001 - Contractor Registration Application/renewal Form - Iowa Division Of Labor Page 2
Download a blank fillable Form 500-001 - Contractor Registration Application/renewal Form - Iowa Division Of Labor in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 500-001 - Contractor Registration Application/renewal Form - Iowa Division Of Labor with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2G
G
G
G
G
G
G
G
G
G
G
G
G
G
G
G
G
G
G
G
.
.
G
G
.
G
Iowa Division of Labor
FOR OFFICE USE ONLY
Contractor Registration
Contractor Registration
1000 East Grand Avenue
CR#:
Des Moines, IA 50309
Application/Renewal Form
UI #:
Phone: 515-242-5871
Fax: 515-725-2427
Check #:
contractor.registration@iwd.iowa.gov
Your application cannot be processed until the following have been completed:
Signed and completed new application/renewal form
Valid unemployment insurance account number - create an account at
NAICS code (business activity)
$50.00 check or money order payable to “Iowa Division of Labor” or signed and notarized fee exemption form
Workers’ Compensation box checked and required documents attached (if applicable)
Out-of-state contractor bond form or letter from the Iowa Department of Transportation (if applicable)
1.
Owner’s name
2.
Business name
3.
DBA
4.
Previous contractor registration #
5.
Phone number
6.
Mobile number
7.
Fax number
8.
Email address
9.
Address
10.
City
11.
State
12.
Zip
13.
County
14.
Owner’s social security #
15.
Business FEIN#
16.
NAICS code #
17.
18.
Unemployment Insurance #
19.
Business type:
Corporation
Partnership
Sole Proprietor
New application
Trustee
Other (i.e. LLC):
Renewal
20.
Name of additional owner, officer, partner or member name
Email address
Phone number
Mailing address
City
State
Zip
Name of additional owner, officer, partner or member name
Email address
Phone number
Mailing address
City
State
Zip
21.
Fee Exemption
I do not qualify
I believe I qualify (Fee exemption form must be completed, signed and notarized)
22.
Workers’ Compensation – Check ONE that applies to your business
I am insured – enclose copy of Workers’ Compensation Insurance certificate listing the Iowa Division of Labor as a certificate holder
I am self-insured – enclose copy of Certificate of Relief issued by the Iowa Insurance Division
I have no employees
23.
Out-of-State Contractor
I am not an out of state contractor
I am an out-of-state contractor (Enclose out-of-state contractor bond form)
24.
I certify that the information on this form and the attachments is true and accurate to the best of my knowledge.
Name of individual completing form
Signature
Email address
Date
If there are additional owners, partners or member names, provide the names and personal information on a separate piece of paper.
500-001
Equal Opportunity Employer/Program
04.20.17
Auxiliary aids and services are available upon request to individuals with disabilities.
Page 2
For deaf and hard of hearing, use Relay 711.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form 309-6701 - Contractor Registration Application/renewal Form/form 60-0126 - Report To Determine Liability
Financial
Form Dci-67 - Criminal History Record Check Billing Form - Iowa Division Of Criminal Investigation
Legal
Contractor Registration Application Form (for New/renewal/change Of Class/change Of Voltage Grade/change Of Area Of Operation/inclusion Of Additional Item Of Work)
Legal
Form 74-026-001-01 - Registration Application For International Fuel Tax Agreement (ifta) Credentials - 2001
Financial
Related Categories
Parent category: Legal