Xvifeid Form – Fill Out and Use This PDF

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State of Florida

Department of Business and Professional Regulation

Construction Industry Licensing Board

Application for Certified General Contractor Who is Qualifying a Business

Form # DBPR CILB 6-A

APPLICATION CHECKLIST - IMPORTANT - Submit all items on the checklist below with your application to ensure faster processing.

APPLICATION REQUIREMENTS

ALL License Applicants must submit:

Fees:

•Applying for initial certification between May 1st of an EVEN year through August 31st of an ODD year - $245.

OR

•Applying for initial certification between September 1st of an ODD year through April 30th of an EVEN year - $145.

•Make check payable to the Florida Department of Business and Professional Regulation.

Credit report containing a credit score (FICO derived) on applicant from a nationally recognized credit reporting agency, which includes a public records statement that records have been checked at local, state, and federal levels. For a list of agencies, visit http://www.myfloridalicense.com/dbpr/pro/cilb/documents/cilb_credit_reporting_agencies.pdf.

•See Section 2(i) of Instructions.

•If credit score is below 660 (FICO derived) applicant must submit a bond or irrevocable letter of credit.

•Note- Fifty percent (50%) of the bond or letter of credit requirement may be met by completion of a 14-hour financial responsibility course approved by the Board. For a list of approved courses, please visit: http://www.myfloridalicense.com/dbpr/pro/cilb/documents/cilb_approved_financial_responsibility_courses.pdf

Credit report on business to be qualified from a nationally recognized credit reporting agency, which includes a public records statement that records have been checked at local, state, and federal levels. For a list of agencies, visit http://www.myfloridalicense.com/dbpr/pro/cilb/documents/cilb_credit_reporting_agencies.pdf.

Electronic fingerprints. See Section 1(b)(ii) of Instructions.

Supporting legal documentation, if necessary. See Section 2(j) of Instructions.

Proof of satisfaction of liens, judgments, and discharge of bankruptcy, if applicable.

Please mail your completed application, documentation and required fee(s) to:

Department of Business and Professional Regulation

2601 Blair Stone Road

Tallahassee, FL 32399-0783

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State of Florida

Department of Business and Professional Regulation

Construction Industry Licensing Board

Application for Certified General Contractor Who is Qualifying a Business

Form # DBPR CILB 6-A

If you have any questions or need assistance in completing this application, please contact the Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.

For additional information see the Instructions at the end of this application.

Section I – Application Type

APPLICATION TYPES (Check only one.)

Certified License and Qualify a Business [0605/1043]

NOTE: If applying with a Financially Responsible Officer, the proposed Financially Responsible Officer must submit the CILB 8 application.

Use this application when you will be qualifying only one business entity.

Section II – Applicant Personal Information

PERSONAL INFORMATION

Social Security Number*

FULL LEGAL NAME

	Last Name		First			Middle	Title	Suffix
	Birth Date (MM/DD/YYYY)			Gender
	/	/		 Male		 Female
			MAILING ADDRESS
	Street Address or P.O. Box
	City					State	Zip Code (+4 optional)
	County (if Florida address)			Country
			CONTACT INFORMATION
	Primary Phone Number		Primary E-Mail Address
		RESIDENCE ADDRESS (IF DIFFERENT THAN MAILING ADDRESS)
	Street Address
	City					State	Zip Code (+4 optional)
	County (if Florida address)			Country

*The disclosure of your Social Security number is mandatory on all professional and occupational license applications, is solicited by the authority granted by 42 U.S.C. §§ 653 and 654, and will be used by the Department of Business and Professional Regulation pursuant to §§ 409.2577, 409.2598, 455.203(9), and 559.79(3), Florida Statutes, for the efficient screening of applicants and licensees by a Title IV-D child support agency to assure compliance with child support obligations. It is also required by § 559.79(1), Florida Statutes, for determining eligibility for licensure and mandated by the authority granted by 42 U.S.C. § 405(c)(2)(C)(i), to be used by the Department of Business and Professional Regulation to identify licensees for tax administration purposes.

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Section II – Applicant Personal Information – continued

		ADDITIONAL CONTACT INFORMATION (OPTIONAL)
	Alternate Phone Number		Fax Number
	Alternate E-Mail Address
		CURRENT/PRIOR LICENSE INFORMATION

If you currently hold or have previously held a business or professional license/registration in Florida or elsewhere, please list each one below (attach additional copies of this page as necessary):

	1.	License/Registration Type	State	Date (From)		Date (To)
				/	/	/	/
	License Number			Name Used
	2.	License/Registration Type	State	Date (From)		Date (To)
				/	/	/	/
	License Number			Name Used
	3.	License/Registration Type	State	Date (From)		Date (To)
				/	/	/	/
	License Number			Name Used

PRIOR NAME INFORMATION

Have you used, been known as, or are you currently known by another name (example - maiden name,

	pseudonym, nickname) or alias other than the name signed to the application?			 Yes	 No
	If your answer is yes, state name or names used below:
	Last Name	First	Middle	Title	Suffix
	Last Name	First	Middle	Title	Suffix
	Last Name	First	Middle	Title	Suffix

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Section III – Qualifications for Certified License

	PART A:	METHOD OF QUALIFICATION

A person will qualify for a certified license by meeting one of the following requirements (check only one box below):

1. Four year construction-related degree from an accredited college (equivalent to three years experience) and one year proven experience applicable to the category for which you are applying.

2. One year experience as a foreman and not less than three years of credits from accredited college-level courses.

3. One year experience as a worker, one year experience as a foreman, and two years of credits from accredited college-level courses.

4. Two years experience as a worker, one year experience as a foreman, and one year of credits from accredited college-level courses.

5. Four years experience as a worker or foreman of which at least one year must have been as a foreman.

6.”Upgrade Method”. A certified residential or building contractor holding an active current license for a minimum of 4 years in the classification in which he or she is certified. If you meet this eligibility requirement you are exempted from the Employment History section of this application. You must provide your license number for verification. See Section 2(f)(vi) of Instructions for more information.

If checked, License # :

 Building

Residential

MILITARY VETERANS: A veteran will qualify for a certified license by meeting on of the following (check only one box below):

1. Three years of military service and one year experience as a foreman applicable to the category for which you are applying.

2. Two years of military service, one year experience as a foreman, and one year experience as a worker or foreman applicable to the category for which you are applying.

3. One year of military service, one year experience as a foreman, and two years experience as a worker or foreman applicable to the category for which you are applying.

Note – your employment history provided in Part B must demonstrate the appropriate time frames based on which method of qualification you selected.

PART B follows on the next page. Please list your employment history for the years of experience required for qualification in Part A. (Use as many sheets as necessary to demonstrate your experience).

NOTE: Applicants for licensure as a Certified General Contractor must have experience in four or more of the experience areas listed in Part B AND must provide at least one year of experience in the construction of structures at least four stories in height, pursuant to Rule 61G4-15.001 (2)(a) and (2)(b), Florida Administrative Code.

TOTAL TIME OF EXPERIENCE FROM EMPLOYMENT HISTORY IN PART B:

Worker _______________ Foreman _______________

Note: The total time should equal or exceed the number of years of experience required for the qualification method selected in Part A.

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		Section III – PART B –Qualifications for Certified License –continued
		EMPLOYMENT HISTORY
		Employer Name and Address:		Dates Employed (mm/yyyy to mm/yyyy):
				Employer Phone Number:
		Name of qualifying contractor for employer:	License number of qualifying contractor:
		Contact Name:	Email:
		Role (Check only one):	Dates of Project (mm/yyyy to mm/yyyy):
		Worker OR Foreman

Experience area(s) covered by project and description of work performed. (Check all that apply.)

 Foundation/Slabs greater than 20,000 sqft.		 Column erection
 Masonry walls		 Formwork for structural reinforced concrete
 Steel erection		 Elevated slabs
Was this experience in the construction of structures 4 stories or higher?  Yes  No
Project Name:
Project Address:
Project Type:	 New Construction		 Renovation
Your job title on the project:
Your duties on the project:

Project specifics (specify the number of stories, square feet, materials, etc.):

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		Section III – PART B – Qualifications for Certified License -continued
		EMPLOYMENT HISTORY
		Employer Name and Address:		Dates Employed (mm/yyyy to mm/yyyy):
				Employer Phone Number:
		Name of qualifying contractor for employer:	License number of qualifying contractor:
		Contact Name:	Email:
		Role (Check only one):	Dates of Project (mm/yyyy to mm/yyyy):
		Worker OR Foreman

Experience area(s) covered by project and description of work performed. (Check all that apply.)

 Foundation/Slabs greater than 20,000 sqft.		 Column erection
 Masonry walls		 Formwork for structural reinforced concrete
 Steel erection		 Elevated slabs
Was this experience in the construction of structures 4 stories or higher?  Yes  No
Project Name:
Project Address:
Project Type:	 New Construction		 Renovation
Your job title on the project:
Your duties on the project:

Project specifics (specify the number of stories, square feet, materials, etc.):

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		Section IV – Business to be Qualified Information
			BUSINESS TO BE QUALIFIED
		Business Name:
		Doing Business As (D/B/A):						Federal Employer ID Number (FEID):
		Business Type:  Sole Proprietor	 LLC		 Corporation Partnership
		Other (please specify):
		Is this business already qualified?  YES			 NO
		If so, provide the License Number under which the business is qualified:
		Qualifier Name:				License Number:
		Qualifier Name:				License Number:
		Qualifier Name:				License Number:
		Qualifier Name:				License Number:
				MAILING ADDRESS
		Street Address or P.O. Box
		City					State			Zip Code
		County (if Florida address)				Country
		BUSINESS CONTACT INFORMATION (IF DIFFERENT THAN APPLICANT INFORMATION)
		Contact Name:
		Phone Number of Contact	E-Mail Address of Contact
		BUSINESS LOCATION ADDRESS (IF DIFFERENT THAN MAILING ADDRESS)
		Street Address
		City					State			Zip Code (+4 optional)
		County (if Florida address)				Country

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Section V – Primary Qualifier Information

PRIMARY QUALIFIER

Name of person legally appointed as the qualifier to act for the business organization in all matters connected with its contracting business, and who has been given authority to supervise all construction work performed by the business (this must be the applicant or a licensed contractor):

Primary Qualifying Agent Name:	License Number (if applicable):

All primary qualifying agents for a business organization are jointly and equally responsible for supervision of all operations of the business organization; for all field work at all sites; and for financial matters, both for the organization in general for each specific job.

If you do not have final approval authority on all business matters for the business organization, it may be in your best interest to appoint a Financially Responsible Officer. The appointment of a Financially Responsible Officer relieves the primary qualifying agent from financial responsibility, but the primary qualifying agent is still responsible for all construction-related matters.

Please check one of the below boxes relating to the financial responsibility of the proposed business:

The business currently has an approved Financially Responsible Officer.

Name and license number of Financially Responsible Officer: ___________________________

The business will appoint a Financially Responsible Officer.

Name of proposed Financially Responsible Officer who will be submitting the CILB 8 application: ____________________________________

The business will not designate a Financially Responsible Officer. As primary qualifying agent I will assume financial responsibility for the business organization.

Section VI – Secondary Qualifier Information (Optional)

SECONDARY QUALIFIER

Name of person legally appointed as a secondary qualifier and is responsible only for the supervision of fieldwork at sites where his or her license was used to obtain the building permit and any other work for which he or she accepts responsibility (this must be the applicant or a licensed contractor):

Secondary Qualifying Agent Name:	License Number (if applicable):

A secondary qualifying agent is not responsible for the supervision of financial matters.

Section VII – Business Ownership

BUSINESS OWNERSHIP

List below the business owners and the percentage of ownership for each. The total must equal 100%. Attach additional copies as necessary.

	Name of Owner	Address	Social Security #/	% of
			FEID	ownership

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Section VIII –Insurance Coverage

INSURANCE

Minimum amounts required for General Liability insurance:

General and Building Contractors - $300,000 public liability; $50,000 property damage

All other categories - $100,000 public liability; $25,000 property damage

1. Have you obtained public liability and property damage insurance in the amounts determined by rule of the Construction Industry Licensing Board, as specified above?  Yes  No

2.Have you obtained workers’ compensation insurance or filed for an exemption with the Division of Workers’ Compensation, and if not, do you attest that you will obtain an exemption within 30 days after

your license is issued?  Yes  No

Section IX – Financial Responsibility & Stability Requirements

FINANCIAL RESPONSIBILITY & STABILITY

See Section 2(i) of Instructions for information on completing this section.

•CREDIT REPORT

The applicant must submit a credit report containing a credit score (FICO derived) from a nationally recognized credit reporting agency, which includes a public records statement that records have been checked at local, state, and federal levels. (See Instructions for more information).

•FINANCIAL RESPONSIBILITY & STABILITY REQUIREMENTS

Financial responsibility & stability can be demonstrated by a credit score of 660 or higher and no unsatisfied judgments or liens. (See Rule 61G4-15.006, Florida Administrative Code for details).

Does the submitted credit report show a credit score of 660 or higher?  Yes  No

If no, the financial stability requirement may be met by providing a bond or irrevocable letter of credit from a bank authorized to do business in the State of Florida,

with proof of completion of an approved 14-hour financial responsibility course, in the amount of:

$10,000 for Division I applicants

$5,000 for Division II applicants

without proof of completion of an approved 14-hour financial responsibility course, in the amount of:

$20,000 for Division I applicants

$10,000 for Division II applicants

Have you completed a financial responsibility course approved by the Construction Industry

Licensing Board?  Yes	 No
If yes, please complete the fields below.
School Name:		School Provider #:

Name of Course:

Date(s) Attended:

If you will be submitting a bond or an irrevocable letter of credit, see page 17 of this application for further instructions.

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Section X – Background Questions

BACKGROUND QUESTIONS

Instructions:

The Applicant and Authorized Representative(s) of the business must answer the background questions in this section.

Authorized Representative(s) of the business are any of the following:

•All officers and directors (if qualified business is a corporation or any other business entity with officers and directors)

•All members and managers (if qualified business is a LLC)

•All partners (If qualified business is a partnership)

•All members (if qualified business is a business entity other than those described above)

NOTE: Accuracy of Authorized Representative(s) of the business may be checked on the Florida Division of Corporations website www.sunbiz.org.

If YES to questions 1 or 2, please complete section XI.

If YES to questions 3 or 4, please complete section XII.

1.Have you ever been convicted or found guilty of, or entered a plea of guilty or nolo contendere to, regardless of adjudication, a crime in any jurisdiction? This question applies to any criminal violation of the laws of any municipality, county, state or nation, including felony, misdemeanor and traffic offenses (but not parking, speeding, inspection, or traffic signal violations), without regard to whether you were placed on probation, had adjudication withheld, were paroled, or pardoned. If you intend to answer “NO” because you believe those records have been expunged or sealed by court order pursuant to Section 943.0585 or 943.059, Florida Statutes, or applicable law of another state, you are responsible for verifying the expungement or sealing prior to answering "NO." YOUR ANSWER TO THIS QUESTION MAY BE CHECKED AGAINST LOCAL, STATE AND FEDERAL RECORDS. FAILURE TO ANSWER THIS QUESTION ACCURATELY MAY RESULT IN THE DENIAL OR REVOCATION OF YOUR LICENSE. IF YOU DO NOT FULLY UNDERSTAND THIS QUESTION, CONSULT WITH AN ATTORNEY OR CONTACT THE DEPARTMENT.

2.Are there any pending bankruptcies or unsatisfied judgments or liens against yourself, a business you previously qualified, which were filed during your period of qualification, or the business you are applying to qualify? This question applies to any unpaid judgments or liens, including those for unpaid past-due bills by creditors, construction and non-construction issues, and tax liens.

3.Have you ever had an application for registration, certification, or licensure in Florida or in any other jurisdiction denied, or is there now pending a proceeding or investigation to deny such an application?

4.Have you ever had any license, registration, or permit to practice any regulated profession, occupation, vocation, or business, revoked, annulled, suspended, relinquished, surrendered, or otherwise disciplined in Florida or in any other jurisdiction, or is any such proceeding or investigation now pending?

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	Section X – Background Questions– continued
							Question Number.
	Person #			Indicate each response by checking “Yes” or “No”	1		2	3	4
				Applicant – Print Name		Yes	Yes	Yes	Yes
	1
						No	No	No	No
				Social Security #:
				Authorized Representative– Print Name		Yes	Yes	Yes	Yes
	2
						No	No	No	No
				Social Security #:
				Authorized Representative – Print Name		Yes	Yes	Yes	Yes
	3
						No	No	No	No
				Social Security #:
				Authorized Representative – Print Name		Yes	Yes	Yes	Yes
	4
						No	No	No	No
				Social Security #:
				Authorized Representative – Print Name		Yes	Yes	Yes	Yes
	5
						No	No	No	No
				Social Security #:
				Authorized Representative – Print Name		Yes	Yes	Yes	Yes
	6
						No	No	No	No
				Social Security #:
				Authorized Representative – Print Name		Yes	Yes	Yes	Yes
	7
						No	No	No	No
				Social Security #:
				Authorized Representative – Print Name
	8					Yes	Yes	Yes	Yes
						No	No	No	No
				Social Security #:
				Authorized Representative – Print Name
	9					Yes	Yes	Yes	Yes
						No	No	No	No
				Social Security #:
				Authorized Representative – Print Name
	10					Yes	Yes	Yes	Yes
						No	No	No	No
				Social Security #:

If you answered “YES” to any question in questions 1 – 4 above, please refer to Sections 2(j-l) of Instructions for detailed instructions for providing complete explanations, including requirements for submitting supporting legal documents. Please complete Section XI for your response to questions 1 and 2, and complete Section XII for your response to questions 3 and 4. If you have more than three offenses to document in Section XI or more than two offenses in Section XII, attach additional pages as necessary.

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Section XI – Explanations for “Yes” answers to Questions 1-2 – Attach additional copies as necessary

EXPLANATION

	This explanation relates to person # (check one):						This explanation relates to question # (check one):
	 1	 2	 3	 4	 5	 ____		 1	 2
	Offense:
	County:					State:		Date of Offense (mm/dd/yyyy):
	Penalty/ Disposition:							Have all sanctions been satisfied?
								 Yes	 No
	Description:
						EXPLANATION
	This explanation relates to person # (check one):						This explanation relates to question # (check one):
	 1	 2	 3	 4	 5	 ____		 1	 2
	Offense:
	County:					State:		Date of Offense (mm/dd/yyyy):
	Penalty/ Disposition:							Have all sanctions been satisfied?
								 Yes	 No
	Description:
						EXPLANATION
	This explanation relates to person # (check one):						This explanation relates to question # (check one):
	 1	 2	 3	 4	 5	 ____		 1	 2
	Offense:
	County:					State:		Date of Offense (mm/dd/yyyy):
	Penalty/ Disposition:							Have all sanctions been satisfied?
								 Yes	 No
	Description:

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Section XII – Explanations for “Yes” answers to Questions 3-4 – Attach additional copies as necessary

EXPLANATION

This explanation relates to person # (check one):	This explanation relates to question # (check one):
 1  2  3  4  5  ____	 3	 4
State/Jurisdiction:	Application Type/License Number:

EXPLANATION

This explanation relates to person # (check one):	This explanation relates to question # (check one):
 1  2  3  4  5  ____	 3	 4
State/Jurisdiction:	Application Type/License Number:

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Section XIII – Affirmation by Written Declaration

AFFIRMATION BY WRITTEN DECLARATION

I certify that I am empowered to execute this application as required by Section 559.79, Florida Statutes. I understand that my signature on this written declaration has the same legal effect as an oath or affirmation. Under penalties of perjury, I declare that I have read the foregoing application and the facts stated in it are true. I understand that falsification of any material information on this application may result in criminal penalty or administrative action, including a fine, suspension or revocation of the license.

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STATE OF FLORIDA

DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION

2601 Blair Stone Road, Tallahassee, FL 32399-0783

CONSTRUCTION LICENSE BOND

STATE OF __________________________

COUNTY OF

Bond #:				Bond Amount: $
Effective Date: ________________________				Type of Bond: Construction License Bond
Obligee: Florida Construction Industry Licensing Board
KNOW ALL PERSONS BY THESE PRESENTS, THAT
(Applicant)		________________________________________________________________________

of (Company Name) ____________________________________________________________________, a company fully

authorized to do business in the State of Florida, as Principal, and

(Bond Company) _________________________________________________________, a company fully authorized to do business

in the State of Florida, as Surety, are held and firmly bound unto the Florida Construction Industry Licensing Board, as Obligee, in Penal Sum of (amount in words) __________________________________________________ Dollars for the payment of fines and

costs pursuant to Rule 61G4-15.006, Florida Administrative Code, well and to truly be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. The condition of this obligation is such that:

WHEREAS, Principal has been granted a license to conduct business under Chapter 455, Florida Statutes and;

NOW THEREFORE, if the (Company Name) ___________________________________________________, shall well and

truly and faithfully make the payments to the State Treasurer of the State of Florida in his capacity as Treasurer of the Department of Business and Professional Regulation as provided in and as required by any and all laws of the State of Florida Business and Professional Regulation, and shall faithfully and accurately keep its books and records and make reports as in any and all of said laws provided and required, and shall conduct its business in conformity with said laws and rules of the Florida Department of Business and Professional Regulation, and shall well and truly keep and perform each and every requirement in and by said laws and rules provided, then this obligation to be null and void, otherwise to remain in full force and effect.

IT IS FURTHER AGREED AND UNDERSTOOD that the Obligee will retain an electronic record of this bond and power of attorney that will be utilized to make claims against this bond pursuant to Section 668.50, Florida Statutes. Collection of claims under this bond shall require a statement signed by a duly authorized official acting on behalf of the Florida Construction Industry Licensing Board, referencing the bond number and certifying that the amount of the draft is due and payable pursuant to a Final Order from the Construction Licensing Board; and a copy of this bond. The Principal shall retain the original bond. The Principal must maintain a license bond in effect until the Principal can demonstrate a credit score of 660 (FICO derived) or higher to the Florida Construction Industry Licensing Board. The Surety reserves the right to cancel this bond by sending a notice of cancellation by certified mail 30 days in advance of cancellation to the Executive Director of the Florida Construction Industry Licensing Board, 2601 Blair Stone Road, Tallahassee, Florida 32399. However, the Surety’s liability shall continue for any indebtedness incurred or accrued during the period of this bond, including the 30-day notice period.

SIGNED this _________ day of __________________________, 20____.

PRINCIPAL: ___________________________________		______________________________________
	Print or Type Name of Applicant	Applicant Signature
COMPANY: ___________________________________		______________________________________
	Authorized Company Officer Name, Title	Signature Authorized Company Officer
SURETY: _____________________________________
BY:	_____________________________________	______________________________________
	Print Name of Attorney-in-fact	Signature Attorney-in-fact
		(Attach Power of Attorney)

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STATE OF FLORIDA

DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION

2601 Blair Stone Road, Tallahassee, FL 32399-0783

CONSTRUCTION LICENSE IRREVOCABLE LETTER OF CREDIT

RE: Irrevocable Letter of Credit No. _____________		Beneficiary:		Construction Industry Licensing Board
Effective Date: ____________________________				2601 Blair Stone Road
Expiration Date: __________________________				Tallahassee, FL 32399-0783
Applicant:
Company Name:
Address:

Lending Institution: _______________________________

Address: ________________________________

________________________________

To the Florida Construction Industry Licensing Board:

We hereby authorize Beneficiary to draw on us, the aforementioned Lending Institution, for account of Applicant up to an aggregate amount of _______________________________________________ Dollars for the payment of fines and costs

pursuant to Rule 61G4-15.006, Florida Administrative Code, available by your draft at sight on us accompanied by the following:

1.A statement signed by a duly authorized official acting on behalf of the Florida Construction Industry Licensing Board, referencing the Irrevocable Letter of Credit number and certifying that the amount of the draft is due and payable pursuant to a Final Order from the Florida Construction Industry Licensing Board.

2.A copy of this Irrevocable Letter of Credit.

The Lending Institution shall retain the original irrevocable letter of credit. The Beneficiary will retain an electronic record of this irrevocable letter of credit that will be utilized to make claims against this letter of credit pursuant to Section 668.50, Florida Statutes. The irrevocable letter of credit must remain in effect until the Applicant can demonstrate a credit score of 660 (FICO derived) or higher to the Lending Institution. Upon proof of the required credit score, the Lending Institution may cancel the irrevocable letter of credit. A cause of action for any indebtedness accrued during the period of the irrevocable letter of credit must be commenced within one year after the expiration date of the letter of credit or one year after the cause of action accrues, whichever occurs later. A cause of action accrues when the breach occurs, regardless of the aggrieved party’s lack of knowledge of the breach. Section 675.115, Florida Statutes.

We hereby agree that all draft(s) drawn under and in compliance with the terms of this credit be duly honored, if drawn and presented to us.

Nothing contained herein shall be construed to extend the gross liability of the Lending Institution to an amount greater than

the aforesaid $

.

This credit is subject to the Uniform Customs and Practice for Documentary Credits (1993), International Chamber of Commerce, Publication Number 500, and engages us in accordance with its terms.

Sincerely,

(Name, Title of Authorizing Officer)

(Signature, Title of Authorizing Officer)

(Date)

ATTEST:

(Name, Title)

(Signature, Title)

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INSTRUCTIONS

If you have any questions or need assistance in completing this application, please contact the Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.

1.General Requirements for Certification

a.Definition of “Certified Contractor”

i.Any contractor who possesses a certificate of competency issued by the Department and who shall be allowed to contract in any jurisdiction in the state without being required to fulfill the competency requirements of that jurisdiction.

b.All License Applicants:

i.Must select one method of qualification and meet the requirements of that method of qualification.

ii.Must submit electronic fingerprints.

(1)Pursuant to Chapter 455, Florida Statutes, electronic fingerprinting is mandatory for all Construction Initial License, Initial Business, Additional Business, Transfer (Change of Status), and Endorsement applications. Electronic fingerprinting allows applicants to have their fingerprints scanned and electronically submitted to the Florida Department of Law Enforcement and Federal Bureau of Investigation.

(2)Electronic Fingerprinting is located at various convenient sites throughout the state. See http://www.myfloridalicense.com/dbpr/servop/testing/documents/finger_faq.pdf for more information.

2.Application Instructions (by section)

a.Section I- Application Type

i.Certified License and Qualify a Business

(1)Select this application type if you will qualify only one business entity with this and any other construction contractor licenses you hold and meet the requirements outlined in 1(b) above.

(2)Complete entire application.

b.Section II- Applicant Personal Information

i.Fill out each section completely. A Social Security number is required in order to apply for any individual license within the Department of Business and Professional Regulation.

ii.In the Full Legal Name section provide your full legal name as it appears on your Social Security card. Do not use any nicknames or initials. Please list any aliases or prior names in the prior name information section.

iii.Provide your mailing address. This will be used for sending correspondence regarding your application and license.

iv.Contact information is often used to quickly resolve questions with applications by telephone call or email. If contact information is not provided, questions regarding applications will be mailed to the applicant’s mailing address and may take longer to resolve.

v.Applicants are required to provide at least one physical address – i.e., not a P.O. Box. If the mailing address is not also your physical address, please provide a physical address.

vi.Additional contact information is optional and will be used when the applicant cannot be reached using their primary contact information.

vii.Applicants must provide information on current or prior licenses held in Florida or any other state, territory, or jurisdiction of the United States or in any foreign national jurisdiction.

viii.Applicants must provide information on any prior names or aliases used by applicant. If the name on supporting documentation does not match the applicant’s legal name, the alias used in the supporting documentation must be provided in this section. Failure to do so will result in a deficient application.

c.Section III – Qualifications for Certified License

i.Definition of “foreman”

(1)Person who is in charge of a group of workers and usually is responsible to a superintendent or a contractor or his or her equivalent

ii.Definition of “worker”

(1)A person who through active experience as a worker has learned the trade by serving an apprenticeship as a skilled worker who is able to command the rate of a mechanic in the particular trade.

iii.Definition of “accredited college-level course”

(1)This refers to academic credit from an accredited college. All junior college or community college- level courses shall be considered accredited college-level courses.

iv.Part A: Method of qualification. Applicant must select one of the following methods of qualification:

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(1)Four year construction-related degree from an accredited college (equivalent to three years experience) and one year proven experience applicable to the category for which you are applying.

(a)Definition of “construction-related degree”, a baccalaureate degree from an accredited 4-year college in the appropriate field of engineering, architecture, or building construction.

(2)One year experience as a foreman and not less than three years of credits from accredited college- level courses.

(3)One year experience as a worker, one year experience as a foreman, and two years of credits from accredited college-level courses.

(4)Two years experience as a worker, one year experience as a foreman, and one year of credits from accredited college-level courses.

(5)Four years experience as a worker or foreman of which at least one year must have been as a foreman.

(6)“Upgrade Method”. A certified residential or building contractor holding an active current licensure for a minimum of 4 years in the classification in which he or she is certified. If you meet this eligibility requirement you are exempted from the Employment History section of this application. You must provide your license number for verification.

(i)An active certified residential contractor is eligible to take the general contractors' examination if he or she possesses a minimum of 4 years of proven experience in the classification in which he or she is certified.

(ii)An active certified building contractor is eligible to take the general contractors' examination if he or she possesses a minimum of 4 years of proven experience in the classification in which he or she is certified.

(7)Note: One year of experience is equal to 2000 hours.

v.Part B: List your employment history for the years of experience required for the method of qualification you selected in Part A.

(1)Provide the name and address of your employer.

(2)Provide the dates of your employment with that employer.

(3)Provide a phone number for the employer.

(4)Provide the name of the qualifying contractor for the employer.

(5)Provide the employer’s license number. This may be the license number of a qualifying contractor who supervised the work you did for the employer. DBPR may contact the supervisor to verify experience.

(6)Provide the name of a contact person for the employer.

(7)Provide an email address for the employer or the contact person for the employer.

(8)Select whether work experience with that employer was as a worker or a foreman, and indicate how many years (yrs) and months (mths) you worked in that capacity.

(a)If you worked as both a worker and foreman for that employer, please check both boxes and indicate the amount of time you worked in each capacity.

(9)Provide the dates that you worked on the project you are using to provide experience.

(10)Select the areas in which you gained experience during your employment history.

(11)Indicate if this experience was in the construction of structures 4 stories or higher.

(12)Provide the project name, address and type.

(13)Provide your job title on the project.

(14)Provide your duties on the project.

(15)Provide a full description of the work performed on the project.

(16)At the bottom indicate the total time of experience as a worker and foreman from your employment history.

(a)Note: the total time should equal or exceed the number of years of experience required for the qualification method selected in Part A.

(17)Use additional copies of this sheet as necessary. d. Section IV- Business to be Qualified Information

i.Complete this section entirely.

ii.Provide the name of the business to be qualified as it is registered with the Florida Division of Corporations.

iii.The “Doing Business As” (D/B/A) name must be provided as it is registered with the Florida Division of Corporations, if the business uses a fictitious name to conduct business.

iv.Applicants must provide the Federal Employer Identification Number (FEID) for the business to be qualified.

v.Select the box that indicates the type of business ownership for the business to be qualified.

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vi.Applicants must state whether the business to be qualified is already qualified by another contractor. If so, provide the qualifying contractor’s name and license number in the spaces provided.

vii.Applicants must provide the business mailing address of the business to be qualified.

viii.Business contact information is often used to quickly resolve questions with applications by telephone call or email. Please provide the name of an authorized representative of the business other than the primary qualifier. This could be an officer, a partner, etc. If the business is a Sole Proprietorship, you may leave the contact information field blank.

(1)If contact information is not provided, questions regarding applications will be mailed to the applicant’s mailing address and may take longer to resolve.

ix.Provide the business location address of the business to be qualified. If this address is the same as the mailing address you may leave this information blank.

e.Section V- Primary Qualifier Information

i.All construction businesses must have a primary qualifier.

ii.If this application is for a business that is not qualified by another contractor, the applicant must be the primary qualifier.

iii.If this application is for a business that is already qualified by another primary qualifier, the applicant may apply to be an additional primary qualifier or a secondary qualifier.

(1)If you will be an additional primary qualifier, complete this section by inserting your name as the “Primary Qualifying Agent.” You will not provide a license number since it has not been issued.

(2)If you will be a secondary qualifier, complete this section by inserting the name and license number of the “Primary Qualifying Agent”; and complete Section VI.

iv.All primary qualifiers are jointly and equally responsible for supervision of all operations of the business organization; for all field work at all sites; and for financial matters, both for the organization in general and for each specific job.

(1)If the primary qualifier does not have final approval authority on all business matters, they may wish to appoint a Financially Responsible Officer. Failure to appoint a Financially Responsible Officer will result in the Primary Qualifier being financially responsible for all construction matters of the business entity.

(a)If the business entity has already appointed a Financially Responsible Officer, provide the name of that individual.

(b)If the business entity has not appointed a Financially Responsible Officer and will appoint someone to be the Financially Responsible Officer in connection with this application, provide the name of that individual (that individual must also submit the CILB 8 application form).

f.Section VI- Secondary Qualifier Information

i.Complete this section entirely, if the applicant will be a secondary qualifier.

g.Section VII- Business Ownership

i.Complete this section entirely.

ii.List the name, address, Social Security number, and percentage of ownership for all persons who have an ownership interest in the business to be qualified.

(1)If an owner of the business is a company, please list the Federal Employer Identification Number (FEID) of the owning company.

iii.The percentage of ownership for all owners together must equal 100%.

h.Section VIII- Insurance Coverage

i.Complete this section entirely.

ii.Applicants must have adequate workers’ compensation and liability insurance as specificied by the Construction Industry Licensing Board.

(1)Amounts for general liability insurance are specified in the application. Amounts for workers’ compensation insurance are outlined in Chapter 440, Florida Statutes.

(2)See Section 489.115(5)(a), Florida Statutes, and Rule 61G4-15.003, F.A.C. for more information.

iii.To verify the accuracy of the signed affidavit, the Board will, from time to time, conduct random sample audits of licensees by zip code area in which the total number of certificates and registrations selected for audit will be in a sufficient amount to insure the validity of the audit.

i.Section IX- Financial Responsibility & Stability Requirements

i.Complete this section entirely.

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ii.Applicants must meet financial responsibility and stability requirements by submitting a credit report with a FICO derived credit score.

(1)Financial responsibility – this requirement is met if the submitted credit report shows no outstanding unsatisfied judgments or liens against the applicant.

(a)Applicants must submit proof of satisfaction of liens, judgments, and discharge of bankruptcy if these are shown on the credit report.

(2)Financial Stability – this requirement is met if the submitted credit report shows a FICO derived credit score of 660 or higher.

(a)If the applicant has a FICO derived credit score less than 660, he or she must maintain a bond or irrevocable letter of credit from a bank in the amounts specified in the application. (See the instructions for the construction license bond/irrevocable letter of credit form at the end of this application).

(b)Fifty percent of the financial stability bond or the letter of credit requirement may be met by completion of a 14-hour financial responsibility course approved by the Board. See Financial Responsibility and Financial Stability, Grounds for Denial Rule 61G4-15.006, F.A.C. for more information.

(3)You only need to complete the 14-hour financial responsibility course if you have a credit score less than 660 (FICO) and wish to meet fifty percent of the financial stability bond or the letter of credit requirement.

(4)If you have completed the 14-hour financial responsibility course for a 50% reduction in the amount required for the construction bond/irrevocable letter of credit, please provide the school name, the school provider number, the name of the course, and the dates attended.

j.Section X- Background Questions

i.The applicant and the authorized representative(s), as specified in the section, must submit answers to each of the background questions.

ii.For each “Yes” answer the person must provide an explanation in Section XI or XII, as applicable.

iii.The number of “Yes” boxes checked must equal the number of explanation boxes completed.

iv.If you answered “YES” to any question, please provide full explanations as required below. If you have more than three offenses to document in Section XI or more than two in Section XII, attach additional copies as necessary.

k.Section XI- Explanations for Background Questions 1 and 2

i.For this section, provide as much detail as possible.

ii.Each explanation can only relate to one person and one question.

iii.Question 1:

(1)If you answer “yes” to this question, you must complete Section XI [make additional copies as necessary] of the application please provide the full details of the criminal charges including dates, outcomes, sentences, and/or conditions imposed; the dates, name and location of the court and/or jurisdiction in which any proceedings were held or are pending. If you answer NO to this question because you believe that previous incidents have been dismissed, no action taken, nolle prossed, or expunged, you may be asked to supply documentation as proof of the disposition.

iv.Question 2:

(1)If you answer “yes” to this question, you must complete Section XI [make additional copies as necessary] of the application and you must also supply documentation proving the bankruptcy has been discharged or the judgment or lien has been satisfied, or if not, stating the current status of the bankruptcy, judgment or lien.

l.Section XII- Explanations for Background Questions 3 and 4

i.For this section, provide as much detail as possible.

ii.Each explanation can only relate to one person and one question.

iii.Question 3:

(1)If you answer “yes” to this question, you must complete Section XII [make additional copies as necessary] of the application and supply copies of documentation explaining the denial or pending action.

(2)Provide the full details explaining the denial or pending administrative action including the nature of any charges, dates, outcomes, sentences, and/or conditions imposed; the dates, name and location of the court and/or jurisdiction in which any proceedings were held or are pending; and the designation and/or license number for any actions against a license or licensure application.

iv.Question 4:

(1)If you answer “yes” to this question, you must complete Section XII [make additional copies as necessary] of the application and supply copies of the order(s) (if applicable) showing the disciplinary action taken against the license or documentation showing the status of the pending action.

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(2)Provide the full details of any administrative action including the nature of any charges, dates, outcomes, sentences, and/or conditions imposed; the dates, name and location of the court and/or jurisdiction in which any proceedings were held or are pending; and the designation and/or license number for any actions against a license or licensure application.

v.Submit supporting legal documentation, if necessary, with this application. m. Section XIII- Affirmation by Written Declaration

i.Applicant must sign the affirmation by written declaration.

DBPR CILB 6-A Certified General Contractor Qualifying Business

July 2021

Incorporated by Rule: 61-35.010