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2. 
4. Section 1: Business Name and Address
   The legal business name is the name that will appear on the license and is the actual name under which the contracting business will operate. The full business name must be provided.
6. Full Business Name*
8. Business Mailing Address*
10. City*
11. State*
12. Zip Code*
14. Business Phone Number*
15. Business Fax Number*
17. Business Website*
21. Section 2: Status of Application
    Indicate the appropriate classification of this application.
23. Application Year:*

    1. May 1, 2023 - April 30, 2024

    Registration is done on a yearly basis and all licenses expire on April 30th, regardless of issue date. If you begin work in the previous year, you must renew your application for the following year. Indicate the yearly license this application coincides with.

24. Check the Appropriate Classification: *

    1. New Application
    2. Renewal Application
    3. Change of Information
26. Type of Contractor or Sub-Contractor
    Please list the area of specialty or a brief description of the type of work the applying company performs.
30. Section 3: Point of Contact
    A contact individual is required for every classification on every license issued by the Village of Elwood. You must provide full legal names of all individuals and qualifiers.
32. First Name*
33. Last Name*
35. Address*
37. City*
38. State*
39. Zip Code*
41. Phone Number*
42. Fax Number
44. E-mail Address*
48. Section 4: List Owners, Officers, Partners and Members
    Where applicable, the following must be completed by all individuals who will be listed on the license. You must provide full legal names of all indivuals.
50. Full Name
51. Title
53. Full Name
54. Title
56. Full Name
57. Title
61. Section 5: Required Application Questions
    All questions must be answered. If you checked 'yes' in response to any of these questions, the person involved must attach a separate sheet with a detailed explanation for each situation.
63. To the best of your knowledge, is anyone listed on this application (or any company the person is or was a part of), named in or responsible for any entered and unsatisfied judgments, liens, and/or claims against any bond or cash deposit pertaining to a construction project? If you checked “Yes” for this question, you are required to attach a statement identifying all judgments (pending or on record), liens, past due unpaid bills, claims, or suits and a detailed explanation of the situation. Include the names and addresses of the parties involved. If the obligation was or is being discharged in bankruptcy, attach a copy of the bankruptcy filing and a copy of the creditors list.*

    1. Yes
    2. No
65. Has any individual listed on this application ever been convicted of or plead guilty to ANY misdemeanor or felony in the United States or a foreign country? If you checked “Yes” for this question, you are required to attach a statement disclosing all pleas/convictions, including violated law sections, and thoroughly explain the acts or circumstances which resulted in the plea/conviction.*

    1. Yes
    2. No
67. To the best of your knowledge, has anyone on this application (or any company the person was a part of) ever received a citation from the Contractors State License Board or had a contractor license or registration denied, suspended, or revoked by this state or elsewhere? (Check “No” if the license was suspended due to lack of a bond, workers’ compensation insurance, a qualifying individual, or family support.) If you checked “Yes” for this question, you are required to attach a statement detailing the events leading to this action.*

    1. Yes
    2. No
71. Section 6: Bond and Insurance Requirements
    Check with your insurance carrier to ensure you are properly covered.
73. Bond Requirements*

    1. I have read and understand the Bond Requirements.

    Prior to the commencement of construction or commencement of any services within the Village of Elwood, each contractor/sub-contractor shall secure a standard license and/or permit indemnity/surety bond in favor of the Village of Elwood in the amount of $10,000. Said bond shall remain in effect for the period of construction or completion of all services by said contractor or sub-contractor, and shall only be released upon written authorization by the Village of Elwood. Therefore, a bond only needs to be issued when a job is scheduled.
75. The Village of Elwood must be listed as a Certificate Holder and issued a valid Certificate of Liability Insurance.*

    1. I have read and understand the Insurance Requirements.

    Commercial General Liability covering the insured against claims of bodily injury, personal injury and property damage (including loss of use thereof) arising out of Seller/Contractor's operations, actions and contractual liabilities including a Broad Form Endorsement covering the insurance provisions of this Agreement, for limits of liability no less than:
77. -Bodily Injury.........................................$1,000,000 each occurrence, $2,000,000 aggregate
79. -Personal Liability Insurance................$1,000,000 each occurrence, $2,000,000 aggregate
81. -Property Damage................................$1,000,000 aggregate
83. All Risk Property Insurance
    All Risk Property Insurance covering all materials, fixtures and personal property of owner in connection with any work conducted by contractor or subcontractor. Such insurance must be written on an "All Risks" of physical loss or damage basis, for the full replacement cost value and shall include coverage for damage or other loss caused by fire or other peril including, but not limited to, vandalism and malicious mischief, theft, water damage of any type, including sprinkler leakage, bursting or stoppage of pipes, and explosion.
85. Workers' Compensation and Employer's Liability
    Workers' Compensation and Employer's Liability, in an amount no less than $1,000,000, or other similar insurance pursuant to all applicable state and local statutes and regulations, whichever is greater.
87. The policies of insurance required hereunder shall name the Village of Elwood as an additional insured and shall be issued by an insurance company having a rating of no less than "B" in the Best's Insurance Guide or which is otherwise acceptable to the Village of Elwood and licensed to do business in the State of Illinois. Said policies of insurance shall provide that said insurance shall not be called or coverage materially changed unless thirty (30) days prior written notice shall have been given to the Village of Elwood.
91. Section 7: Review, Submit Attachments and Indicate Payment
    Double check your form and attachments.
93. Indicate Payment Method:*

    1. Check
    2. Credit Card
    3. Cash

    Contractor Registration requires payment of the current registration fee of $100. Please see the 'Information' section below for details on where to submit payment.

95. Information

    Please submit any additional information, or attachments by email to buildingpermits@villageofelwood.com, or by mail to Village of Elwood, 401 East Mississippi Avenue, Elwood, IL 60421. You can make your payment by following the link below.

    https://magic.collectorsolutions.com/magic-ui/Login/village-of-elwood

97. Before submitting the application, ensure the necessary information has been included and all requirements have been met: *

    1. Certificate of Liability
    2. Bond Requirements (if applicable)
    3. Supporting Documents for Section 5 (if applicable)
99. Certificate of Liability

    Please attach the Certificate of Liability naming the Village of Elwood as a Certificate Holder.

101. Bond Requirements

     IF REQUIRED: Please attach the Bond Requirements: $10,000.00

103. Supporting Documents
     IF REQUIRED: Please attach any supporting documents that are necessary to complete the application.
107. Section 9: Applicant Conditions with Signature
     Read through the application thoroughly and understand the Village of Elwood ordinances and permit requirements.
109. Conditions
     In consideration of this application and attached forms being made a part thereof, the applicant will conform to the regulations set forth in the Village of Elwood codes and ordinances. The applicant's signature below indicates the information contained in this application and on any accompanying documents is true and correct. This is to certify, I am authorized to renew/apply for this license on behalf of any other owner(s) of the licensed entity and that all owners/officers/partners/members/qualifying agents are aware of the following: -All information and attachments, including financial statement(s) for the licensed entity is true and correct. -The Village of Elwood may refuse to renew a license for lack of insurance. I do hereby state under oath that I will not violate any of the Village of Elwood ordinances in the conduct of my/our business. Furthermore, I state that I understand the Village of Elwood's building codes, inspection requirements and conduct of business regulations.
111. Electronic Signature*
     By providing this Electronic Signature Acknowledgment Form, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.
112. Date*
Leave This Blank:


118. 1. Receive an email copy of this form.
119. Email address

     This field is not part of the form submission.

120. Submit Submit and Print

* indicates a required field