Sfn 12011 Form PDF Details

Are you an employer looking for more information on how to complete your Sfn 12011 form? If so, you've come to the right place! In this blog post, we'll provide a detailed breakdown of what is included in the Sfn 12011 form and everything you need to know before submitting it. We'll be discussing topics such as rules and regulations, deadlines, potential penalties and fees related to inaccuracies or omissions of information, and helpful links where employers can find additional resources. Whether you are just starting out with filing Sfn 12011 forms or already have some experience with them – this blog post will help guide you through all the necessary steps.

QuestionAnswer
Form NameSfn 12011 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesfalse, nd secretary of state forms sfn12011, sfn 12012, north dakota form sfn 12011

Form Preview Example

CONTRACTOR LICENSE RENEWAL APPLICATION

SECRETARY OF STATE

SFN 12011 (12-07)

DUE: MARCH 3, 2008

FOR OFFICE USE ONLY

ID #

WO #

License #

Class of License

 

Business Telephone #

 

 

Business Federal ID #

Business Type

 

 

 

 

 

 

 

 

 

 

 

Certificate of Liability Insurance expires on:

 

 

 

 

 

Renewal Fee

ND Sales and Use Tax Permit #

If expiration date is prior to date of this renewal, please provide a current certificate

 

$

 

 

 

 

 

 

 

 

 

 

 

 

Applicant's name as currently licensed with this office.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E-mail Address

 

 

 

Web Address

 

 

ND Workforce Safety & Insurance

 

 

 

 

 

 

 

 

 

 

Account #

 

 

 

 

 

 

 

1.

Do you have a North Dakota Sales and Use Tax permit?

Yes

No

If yes, record the account number in the above box. For information regarding

 

sales and use tax permits, contact the North Dakota Tax Department at 701-328-3470.

 

2.

Did you have any employees during this reporting period?

Yes

No

If yes, record the Workforce Safety & Insurance account number in the above

 

box. For information regarding Workforce Safety & Insurance, contact 701-328-3800.

 

3.

Is the information listed above, including address, still correct?

Yes

No If no, please make corrections.

 

4.

Name of contact person for this report _________________________________________ Daytime Telephone # (____)_____________.

5.

MUST BE ANSWERED Have you completed any work during the preceeding calendar year, in NORTH DAKOTA, where the project, contract, or subcontract amount has exceeded $25,000 per job?

Yes - If yes, continue with instructions

No - If no, proceed to question #6

INSTRUCTIONS

1.List the names and addresses of any companies or individuals for whom you completed a project, contract, or subcontract during the preceeding calendar year in North Dakota in excess of $25,000.00. (Reference North Dakota Century Code, Section 43-07-10.)

2.Identify the type of work completed.

3.Specify the dollar value of the work.

4.If a performance bond was required, list the name and address of the issuing company. If no performance bond was required, write "None".

 

 

2. TYPE OF WORK

3. VALUE OF WORK

4. PEFORMANCE BOND

 

 

 

 

1. NAME

CITY, STATE

COMPLETED

COMPLETED

NAME

CITY, STATE

(Example) John Doe Co.

Bismarck, ND

Concrete Work

$25,000

None

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ALL OF THE FOLLOWING QUESTIONS MUST BE ANSWERED.

6. If your answer is "YES" to any of the following questions, give the details on a separate sheet and attach to this application.

a. Has any license been denied, suspended or revoked

Yes

No

For you?

For any officer?

Yes

No

For any partner?

Yes

No

For any entity with which you, officers or

 

 

partners have any interest in or are

 

 

associated with?

Yes

No

b. Have you or a corporation, limited liability company, or partnership of which you are or were an officer or partners, been charged with a civil lawsuit in

which fraud or misrepresentation was charged or alleged?

Yes

No

 

(CONTINUED ON BACK)

SFN 12011 (12-07) Page 2

c.Have you or a corporation, limited liability company, or partnership of which you are or were an officer or partner, been involved in or initiated bankruptcy or insolvency proceedings during the past five years?

Yes

No

d.Are there any judgments, arbitration awards, mechanics liens or federal or state tax liens against you, or a corporation, limited liability company, or partnership of which you are an officer or partner, in North Dakota or elsewhere?

Yes

No

e. Has the applicant, or officers or partners of the applicant been charged with or convicted of a felony or misdemeanor within the last five years?

Yes

No If Yes, indicate the date, name of the individual charged or convicted, city, state, disposition, and whether a felony or misdemeanor. (This includes ALL crimes, including nonsufficient funds checks, no account checks, and DUIs.)

7.North Dakota Century Code, Section 43-07-19 states every applicant who is not a resident of the state of North Dakota, by signing and filing the application appoints the Secretary of State as the applicant's true & lawful agent upon whom may be served all lawful process in any action or proceeding against such non-resident contractor.

The undersigned, who is 18 years of age or older, hereby certifies that all payroll taxes (including North Dakota income tax and premiums for workforce safety & insurance and unemployment insurance) due and payable on the day of this application have been submitted and that all of the information provided on the renewal application is true and complete.

Signature of Owner*, Partner, or Authorized Officer

Date

*If a sole proprietorship business structure, a spouse is not authorized to sign on behalf of the owner.

FEES:

 

 

 

 

 

 

 

 

TOTAL PAYABLE

NEW LICENSE

 

CONTRACTOR LICENSE

RENEWAL FEES

PENALTY FEES

 

AFTER MARCH 3 AND

FEES

 

 

 

 

 

 

 

ON OR BEFORE JUNE 2

 

 

 

 

 

 

 

 

 

Fee $300.00

Class A

for contracts over

$250,000

Fee $60.00

Additional $45.00

 

Total

$105.00

Fee $200.00

Class B

for contracts up to

$250,000

Fee $40.00

Additional $30.00

 

Total

$ 70.00

Fee $150.00

Class C

for contracts up to

$

120,000

Fee $30.00

Additional $22.50

 

Total

$ 52.50

Fee $ 50.00

Class D

for contracts up to

$

50,000

Fee $10.00

Additional $ 7.50

 

Total

$ 17.50

 

 

 

 

 

 

 

 

 

 

INSTRUCTIONS:

1.The provisions for contractor licensing are found in Chapter 43-07 of the North Dakota Century Code.

2.The renewal deadline for a contractor's license is March 3, 2008. If not renewed by that date, the current contractor's license automatically expires and completing any work over $2,000 per job would be in violation of 43-07.

3.If the license renewal application is filed after the deadline, state law requires the payment of a penalty fee. This penalty fee must be submitted along with the renewal application and renewal fee at the time the late application is filed. The penalty fees are listed above.

4.Contractor license renewal applications will not be accepted after June 2, 2008. After that date, a previously licensed contractor must submit an application for a new license and pay the appropriate new contractor license fees.

5.If the pre-printed information on this renewal application is incorrect, please cross out the incorrect information and provide the correct information and initial the change.

6.By law, a contractor's license cannot be renewed unless a copy of the contractor's current certificate of liability insurance is on file with the Secretary of State's office. A new certificate is not needed if the pre-printed expiration date at the top of the front page is later than the filing date of this renewal application.

7.Questions #5 and #6 must be answered with either a yes or no. If yes, provide the requested information. Use more sheets, if necessary.

8.The renewal application must be signed by the owner, partner, or authorized officer. If the renewal application contains false information, the contractor's license is subject to revocation under the provisions of state law.

9.Checks for renewal and penalty fees must be made payable to the Secretary of State. The Secretary of State accepts VISA, Master Card, and Discover charge cards. If you wish to pay by credit card, complete the enclosed charge card authorization.

10.In addition to a contractor's license, you may need to obtain other licenses or permits as required by law (for example, including but not limited to the State Electrical Board and the State Plumbing Board).

FAX FILING: A document and Credit Card Payment Authorization may be faxed to 701-328-1690. A faxed filing does not expedite the process of the document in the office of the Secretary of State.

MAILING INSTRUCTIONS: Send the completed renewal application to:

Secretary of State

State of North Dakota

600 E Boulevard Ave Dept 108

Bismarck ND 58505-0500

Telephone: 701-328-3665 Toll Free: 800-352-0867 (ext. 8-3665) Fax: 701-328-1690 Web Page: www.nd.gov/sos/

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For you to fill out this PDF document, make certain you enter the required details in every single area:

1. Whenever completing the nd secretary of state forms sfn12011, make certain to complete all of the necessary blank fields in their relevant part. This will help facilitate the process, allowing for your details to be handled without delay and correctly.

Filling in segment 1 in form 12011 nd

2. Right after completing the previous step, head on to the next part and fill out the necessary particulars in all these fields - Did you have any employees during, Yes, If yes record the Workforce Safety, Is the information listed above, Yes, No If no please make corrections, Name of contact person for this, MUST BE ANSWERED Have you, Yes If yes continue with, No If no proceed to question, List the names and addresses of, If no performance bond was, INSTRUCTIONS, NAME, and CITY STATE.

Yes, If no performance bond was, and NAME inside form 12011 nd

3. Completing If your answer is YES to any of, a Has any license been denied, For you, For any officer, For any partner For any entity, Yes, Yes, Yes, Yes, Have you or a corporation limited, Yes, and CONTINUED ON BACK is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Completing section 3 of form 12011 nd

Always be extremely attentive while filling out For you and CONTINUED ON BACK, because this is where many people make mistakes.

4. You're ready to begin working on this fourth form section! Here you'll have these Have you or a corporation limited, Yes, Are there any judgments, Yes, Has the applicant or officers or, Yes, No If Yes indicate the date name, North Dakota Century Code Section, The undersigned who is years of, FEES, NEW LICENSE, FEES, Signature of Owner Partner or, Date, and If a sole proprietorship business blanks to fill in.

Date, Yes, and Yes in form 12011 nd

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