304 Central Ave, Wiggins, Colorado 80654 Phone: (970) 483-6161 Fax: (970) 483-7364
Town of Wiggins
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Limited Liability Company
please check one
Mailing Address - Mark "Same" if same as above.
if different than above
Company Phone Number
Company Website (optional)
Number of Employees
License Information (please list the licenses you have)
State Contractor License #
State Master License #
General Liability Policy #
Master License Expiration Date
GL Expiration Date
Have you ever been licensed with the Town of Wiggins?
Have you ever had a license revoked?
If yes, please explain:
Please email the following submittal requirements to email@example.com.
Please check each box below confirming that you have provided the Town of Wiggins with all of the following:
Proof of property and liability insurance in the minimum amount of $250,000 per person, $500,000 aggregate, and $125,000 for property damage (a one million dollar liability / property insurance is required if the contractor will be doing work on town property or its right-of-ways / utilities
State contractor’s license and state master’s license numbers
All are required.
Please check each box below affirming that you have read and understand each statement. As a Town of Wiggins Licensed Contractor, and by my signature affixed hereto, I understand that:
Applicable site-specific permits must be issued prior to commencement of any work.
Construction must be completed in accordance with approved plans and the Town’s regulations.
All applicable inspections related to any site-specific permit must be scheduled with the Town of Wiggins @ 970-483-6161.
Building plans (if applicable), permits, and inspection records must be accessible on the job site.
Job site sanitary facilities and safety measures to protect workers and the general public must be adequate.
Proper supervision of all subcontractors and employees will be provided.
Any changes affecting this license will be reported to the Town of Wiggins immediately.
False or misleading statements on this application are grounds for disapproval or revocation of this license.
The content of this application is true to the best of my knowledge and belief.
Note: Entering your name below constitutes your signature.
Please email the following to firstname.lastname@example.org
Certificate of Insurance
Copy of State of Colorado Master License or License
304 Central Avenue, Wiggins, CO 80654
M-F: 8:30 am-4:30 pm
Town Hall (970) 483-6161
Fax (970) 483-7364
Copyright © 2017 Town of Wiggins
This institution is an equal opportunity provider.
derechos de autor © 2017 Ciudad de Wiggins Esta institución es un proveedor de igualdad de oportunidades.