Combined Registration Application For State Of Delaware Business License And/or Withholding Agent

Combined Registration Application For State Of Delaware Business License And/or Withholding Agent - 2000 Page 4

SPECIAL REQUIREMENTS FOR CONTRACTORS

ALL RESIDENT AND NON-RESIDENT CONTRACTORS must complete the following check list and attach all required

documentation and this form to their Combined Registration Application. Please see the instructions on the back of this form. You

should also get a copy Technical Information Memorandum TIM 93-5 for contractors. If you did not receive the required forms or if

you have questions, contact the Division of Revenue at (302) 577-8205.

RESIDENT CONTRACTORS

Check Off

DEPARTMENT OF LABOR FORM UC-1 (Must be completed and attached even if you do not have employees).

INDUSTRIAL ACCIDENT BOARD FORM (Must be completed and attached even if you do not have employees).

Will you subcontract?

YES

If yes, complete and attach Division of Revenue Form 5060, Statement of

Contractors Awarded by General Contractors and Subcontractors. The civil penalty for failure or refusal to comply with

this section is a fine of up to $10,000 for each occurrence.

Are you applying for a business license for bidding purposes only?

YES

Complete Part C of the Combined Registration Application and attach your check for the license fee.

The license fee is not required if the application is being submitted for bidding purposes only.

NON-RESIDENT CONTRACTORS

DEPARTMENT OF LABOR FORM UC-1 (Must be completed and attached even if you do not have employees).

INDUSTRIAL ACCIDENT BOARD FORM (Must be completed and attached even if you do not have employees).

Will you subcontract?

If yes, complete and attach Division of Revenue Form 5060, Statement of

YES

Contractors Awarded by General Contractors and Subcontractors. The civil penalty for failure or refusal to comply with

this section is a fine of up to $10,000 for each occurrence.

Are you applying for a business license for bidding purposes only?

YES

Non-resident contractors must supply a bond equal to 6% of the contract(s) totaling $20,000 or more with this

application. If you don't have a bonding requirement at this time, check the box on this line and skip item number 6.

A bond is required at the time when the total of all contracts exceeds $20,000.

Name & Address of person(s) with whom you have this contract(s)

Contract Period

Contract Amount $

Total Contracts

x .06

= $

(Amount of Bond)

Type of Bond:

Cash (Attach Form 1125-C)

Surety (Attach Form 1125)

Name of Bonding Company

Bond Number

Value $

Letter of Credit

Bank Name

(Requires Director of Revenue's approval.)

Complete Part C of the Combined Registration Application and attach your check for the license fee.

The license fee is not required if the application is being submitted for bidding purposes only.

I declare under penalties as provided by law that this application has been examined by me and to the best of my knowledge

and belief is a true, correct and complete statement.

Signature

Title

Date

Combined Registration Application For State Of Delaware Business License And/or Withholding Agent - 2000 Page 4

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