-
ARIZONA REGISTRAR OF CONTRACTORS
Douglas A. Ducey, Governor Jeff Fleetham, Director
1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ●
www.roc.az.gov
License Application (LLC) Form RC-L-200B Rev. December 23, 2020
Instructions
LICENSE APPLICATION (LIMITED LIABILITY COMPANY)
THIS APPLICATION IS FOR LLCS ONLY This License Application is
for an LLC seeking to obtain an Arizona Contractor’s License.
If the Applicant is a sole-proprietorship, use the
Sole-Proprietorship License Application Form. A sole proprietorship
is a business owned and controlled by one person.
If the Applicant is a corporation, use the Corporation License
Application Form.
If the Applicant is a partnership, use the Partnership License
Application Form.
If the Applicant is a tiered entity, please contact the
Registrar’s Licensing Department at (602) 542-1525 for assistance.
A Tiered Entity is an entity that is owned or operated by another
entity.
• For example, if “Red Corporation” is owned or operated by
“Blue, LLC,” “Red Corporation” wouldbe considered a Tiered Entity
for the purposes of obtaining a contractor’s license.
STEPS TO OBTAIN A CONTRACTOR’S LICENSE To obtain an Arizona
Contractor’s License, complete the following:
1) Identify a Qualifying Party: The Applicant must identify a
Qualifying Party for the license. AQualifying Party is a regularly
employed person with the necessary experience, knowledge andskills
as defined under A.R.S. § 32-1122(E).
2) Pass Examination(s). The Qualifying Party must pass the
required exams by at least 70% andsubmit exam results. The
Qualifying Party must complete a statutes and rules exam (SRE) and
aspecific trade exam, unless eligible for a waiver.
• To determine which exams are required for a specific license
classification, refer to theRegistrar’s License Classification
Requirements.
• The Qualifying Party can register to take an exam through PSI
Exams Online.• For information about PSI’s testing procedures,
refer to PSI's Candidate Information
Bulletin.3) Submit to Background Checks. The Qualifying Party
listed in Part 2, and each individual listed in
Part 3: Persons in this License Application must submit copies
of the payment transactionreceipt from their background checks.
4) Form a Legal Entity. Form or register an LLC with the Arizona
Corporation Commission.5) Bond. The Applicant must obtain and
submit proof of a license Bond.6) Pay the Fees. Include the
required fees and assessments with your License Application
form.
(continued on next page)
http://www.roc.az.gov/https://roc.az.gov/sites/default/files/forms/RC-L-200A-License%20Application-Sole%20Prop.pdfhttps://roc.az.gov/sites/default/files/forms/RC-L-200C%20-License-Application-Corporation.pdfhttps://roc.az.gov/sites/default/files/forms/RC-L-200D-License-Application-Partnerships_0.pdfhttps://roc.az.gov/sites/default/files/files/2017_License_Classification_Requirements.pdfhttps://candidate.psiexams.com/catalog/displayagencylicenses.jsp?catalogID=337https://candidate.psiexams.com/bulletin/display_bulletin.jsp?ro=yes&actionname=83&bulletinid=503&bulletinurl=.pdfhttps://candidate.psiexams.com/bulletin/display_bulletin.jsp?ro=yes&actionname=83&bulletinid=503&bulletinurl=.pdfhttps://roc.az.gov/background-checkshttp://www.azcc.gov/https://roc.az.gov/bond-informationhttps://roc.az.gov/license-fees
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ARIZONA REGISTRAR OF CONTRACTORS
Douglas A. Ducey, Governor Jeff Fleetham, Director
1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ●
www.roc.az.gov
License Application (LLC) Form RC-L-200B Rev. December 23, 2020
Instructions
7) Government-Issued Identification. The Qualifying Party listed
in Part 2, and each individuallisted in Part 3: Persons in this
License Application must submit a copy of their governmentissued
identification with the application.
8) Complete and Submit This Application. Complete and submit
this License Application Form tothe Registrar using one of the
following methods:
Mail to: Registrar of Contractors P.O. Box 6748 Phoenix, AZ
85005-6748
Hand-deliver to: Registrar of Contractors 1700 W. Washington
Street, Suite 105 Phoenix, AZ 85007-2812
Apply Online at: https://roc.az.gov/online-services
WAIVERS Some of the requirements listed above may be waived
depending on an Applicant’s past experience in the contracting
field. To determine if a waiver applies to your application, refer
to the Registrar’s online Waiver Eligibility page.
AGENCY DISCLOSURE Pursuant to A.R.S. § 41-1030(G), the Registrar
provides the following disclosures:
• A.R.S. § 41-1030(B): An agency shall not base a licensing
decision in whole or in part on alicensing requirement or condition
that is not specifically authorized by statute, rule or statetribal
gaming compact. A general grant of authority in statute does not
constitute a basis forimposing a licensing requirement or condition
unless a rule is made pursuant to that generalgrant of authority
that specifically authorizes the requirement or condition.
• A.R.S. § 41-1030(D): This section may be enforced in a private
civil action and relief may beawarded against the state. The court
may award reasonable attorney fees, damages and all feesassociated
with the license application to a party that prevails in an action
against the state for aviolation of this section.
• A.R.S. § 41-1030(E): A state employee may not intentionally or
knowingly violate this section. Aviolation of this section is cause
for disciplinary action or dismissal pursuant to the
agency'sadopted personnel policy.
• A.R.S. § 41-1030(F): This section does not abrogate the
immunity provided by § 12-820.01 or 12-820.02.
***DO NOT SUBMIT THESE INSTRUCTIONS WITH YOUR APPLICATION***
http://www.roc.az.gov/https://roc.az.gov/online-serviceshttps://roc.az.gov/applying-license#waiver
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1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ●
www.roc.az.gov
License Application (LLC) Form RC-L-200B Rev. December 23, 2020
Page 1 of 11
Form RC-L-200B
LICENSE APPLICATION (LLC)
For Internal Use Only
Pending #______________
PART 1: APPLICANT INFORMATION To avoid delay or denial, the
Applicant must completely and accurately fill out the following
information.
• An Authorized Representative is a person with the authority to
sign on behalf of the LLC. • The business address you provide will
be publicly available on the Registrar’s website.
o An applicant must provide an address or location of the
applicant’s place of business, and a mailing address if it is
different from the applicant’s place of business. A.R.S. §
32-1122(B)(1)(h).
• To determine the appropriate License Classification
Description in box 5, refer to the Registrar’s License
Classifications located at
https://roc.az.gov/license-classifications.
1. Limited Liability Company Name 2. Fictitious Trade Name (i.e.
DBA), if applicable.
3. Authorized Representative’s Name 4. Arizona Corporation
Commission File Number
5. Requested License Classification Description
6. Business Address (No PO Boxes or Private Mail Boxes) City
State Zip Code
7. Mailing Address (If different than business address) City
State Zip Code
8. Phone Number 9. Email Address
10. Prior to completing this application, did you or any other
member of your organization participate in or watch a video of the
Registrar’s ‘Applicant Education Seminar’?
(Yes) (No)CONSENT Enter [Email / Telephone]
10. I consent to receive notifications from the Registrar
byemail at the following email address
..........................................................
11. I consent to receive notifications from the Registrar bytext
messaging at the following telephone number
....................
Workers’ Compensation Coverage Applicants are required to be in
compliance with the statutes and rules governing Workers’
Compensation coverage. See A.R.S. § 32-1122(B)(1)(i). In general,
if you have any employees, you must have Workers' Compensation
insurance. Please choose your Workers’ Compensation Coverage type
from the list below: 1. Workers’ CompensationInsurance:
Policy Number Company Issuing Policy
2. Self-Insured Employer (You Must Submit Documentation Showing
Proof of Coverage with this Application)
3. Exemption: Single-Member LLC without any employees, or 50/50
Two-Member LLC without any employees. (YES) (NO)
http://www.roc.az.gov/https://roc.az.gov/license-classifications
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1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ●
www.roc.az.gov
License Application (LLC) Form RC-L-200B Rev. December 23, 2020
Page 2 of 11
PART 2: QUALIFYING PARTY QUALIFYING PARTY
The "Qualifying Party" is a person who is regularly employed by
the Applicant and is actively engaged in the classification of work
for which the person qualifies on behalf of the Applicant. The
Qualifying Party must have the necessary experience, knowledge and
skills to supervise or perform the contracting work.
A.R.S. § 32-1127 The Qualifying Party listed below may be listed
as the qualifying party for up to two licensees, but only when:
1. There is a common ownership of at least twenty-five per cent
of each licensed entity for which the person acts in a qualifying
capacity; or
2. One licensee is a subsidiary of another licensee for which
the same person acts in a qualifying capacity. "Subsidiary" as used
in this section means a corporation of which at least twenty-five
per cent is owned by the other licensee.
1. Name as it appears on your government issued ID 2.
Title/Position 3. Ownership %
4. Date of Birth (MM/DD/YYYY) 5. Driver’s License or Government
ID No. 6. Social Security Number 7. Are you a U.S.
Citizen?
8. Residential Address City State Zip Code
9. Mailing Address (If different than residential address) City
State Zip Code
10. Phone Number 11. Email Address
CONSENT Enter [Email / Telephone]
12. I consent to receive notifications from the Registrarby
email at the following email address
.............................................
13. I consent to receive notifications from the Registrarby text
messaging at the following telephone number ....... “Notifications”
include renewal notices and monthly newsletters. By consenting to
receive notifications via text or email, you will not be excluded
from receiving notifications by regular mail. You consent by
entering the information above.
RELEVANT EXPERIENCE The Qualifying Party must demonstrate
sufficient experience as required by the desired license
classification. The required amount of experience can be determined
by referring to the License Classification Requirements table.
Technical training, military service, diplomas, or certifications
may be submitted to substantiate experience, or a portion of
experience.
• Under A.R.S. § 32-1122(E)(1), at least two years of experience
must be earned within the last ten years. • If additional space is
needed, complete and attach as many “Additional Relevant
Experience” pages as necessary.
1. Business Name of Employer or “Self-Employed”
2. Duration of Experience (e.g. “1/1/2007 through 1/1/2017”) 3.
Average Hours Worked Per Week
4. Position(s) 5. Size of Projects Qualifying Party Worked On
(Square Foot and/or Dollar Amount)
http://www.roc.az.gov/https://www.azleg.gov/ars/32/01127.htmhttps://roc.az.gov/sites/default/files/files/2017_License_Classification_Requirements.pdf
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1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ●
www.roc.az.gov
License Application (LLC) Form RC-L-200B Rev. December 23, 2020
Page 3 of 11
6. Description of Qualifying Party’s Main Duties
EXPERIENCE REFERENCE Include the name and contact information
for a reference who can verify the Qualifying Party’s experience.
The reference must have direct, first-hand knowledge of the
Qualifying Party’s experience. The reference cannot be a person
named on the license application. 7 Reference’s Name 8. Reference’s
Relationship to Qualifying Party (e.g. “Co-worker”; “Employer”;
“Supervisor”)
9. References Mailing Address City State Zip Code
10. Reference’s Phone Number 11. Reference’s E-mail
http://www.roc.az.gov/
-
1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ●
www.roc.az.gov
License Application (LLC) Form RC-L-200B Rev. December 23, 2020
Page 4 of 11
ADDITIONAL RELEVANT EXPERIENCE (IF NECESSARY) The Qualifying
Party must demonstrate sufficient experience as required by the
desired license classification. The required amount of experience
can be determined by referring to the License Classification
Requirements table. Technical training, military service, diplomas,
or certifications may be submitted to substantiate experience, or a
portion of experience.
• Under A.R.S. § 32-1122(E)(1), at least two years of experience
must be earned within the last ten years prior. • If additional
space is needed, complete and attach as many “Additional Relevant
Experience” pages as necessary.
1. Business Name of Employer or “Self-Employed”
2. Duration of Experience (e.g. “1/1/2007 through 1/1/2017”) 3.
Average Hours Worked Per Week
4. Position(s) 5. Size of Projects Qualifying Party Worked On
(Square Foot and/or Dollar Amount)
6. Description of Qualifying Party’s Main Duties
EXPERIENCE REFERENCE Include the name and contact information
for a reference who can verify the Qualifying Party’s experience.
The reference must have direct, first-hand knowledge of the
Qualifying Party’s experience. The reference cannot be a person
named on the license application. 7 Reference’s Name 8. Reference’s
Relationship to Qualifying Party (e.g. “Co-worker”; “Employer”;
“Supervisor”)
9. References Mailing Address City State Zip Code
10. Reference’s Phone Number 11. Reference’s E-mail
http://www.roc.az.gov/https://roc.az.gov/sites/default/files/files/2017_License_Classification_Requirements.pdf
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1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ●
www.roc.az.gov
License Application (LLC) Form RC-L-200B Rev. December 23, 2020
Page 5 of 11
PART 3: PERSONS
COMPLETE AND ATTACH ADDITIONAL PART 3S AS NECESSARY TO PROVIDE
THE INFORMATION FOR ALL OF THE FOLLOWING PERSONS ON THE
LICENSE.
• Owners of 25% or more of the stock or beneficial interest of
the LLC. • If the Applicant is a Member-Managed LLC, then complete
Part 3 for each Member. • If the Applicant is a Manager-Managed
LLC, then complete Part 3 for each Manager.
This information is required under A.R.S. § 32-1122(B)(1)(d).
Every person listed on this application must be 18 years of age or
older and must sign this application form under Part 6:
Signatures.
Arizona Corporation Commission Documents To determine which
individuals are members or managers of an LLC, refer to the LLC’s
entity documents. Entity documents can be located using the
Corporation Commission’s search tool located at
http://ecorp.azcc.gov/Search.
• If any corporation, LLC, partnership, trust, or other business
organization is listed on the applying entity’s Arizona Corporation
Commissiondocuments, then please contact the Registrar’s Licensing
Department at (602) 542-1525 for assistance on completing the
tiered entity organization chart.
This application is for a:
Member-Managed LLC Manager-Managed LLC MEMBER / MANAGER
The Registrar requires all of the information below for each
member (if the applicant is a member-managed LLC) or each manager
(if the applicant is a manager-managed LLC). 1. Name as it appears
on your government-Issued ID
2. Title/Position (“Member” or “Manager”) 3. Ownership % 4. Date
of Birth (MM/DD/YYYY)
5. Identification No. (Driver’s License or Government ID No.) 6.
Social Security Number 7. Are you a U.S. Citizen?
8. Business or Residential Address City State Zip Code
9. Mailing Address (If different than business or
residential
address)
City State Zip Code
10. Phone Number 11. Email Address
CONSENT Enter [Email / Telephone] 12. I consent to receive
notifications from the Registrar by email atthe following email
address
......................................................................................................
13. I consent to receive notifications from the Registrar by
textmessaging at the following telephone number
.....................................................
“Notifications” include renewal notices and monthly newsletters. By
consenting to receive notifications viatext or email, you will not
be excluded from receiving notifications by regular mail. You
consent by entering
http://www.roc.az.gov/http://ecorp.azcc.gov/Searchhttps://roc.az.gov/sites/default/files/forms/RC-L-%20205D%20Tiered%20Entity%20Org%20Chart%20Inst._0.pdfhttps://roc.az.gov/sites/default/files/forms/RC-L-%20205D%20Tiered%20Entity%20Org%20Chart%20Inst._0.pdf
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1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ●
www.roc.az.gov
License Application (LLC) Form RC-L-200B Rev. December 23, 2020
Page 6 of 11
the information above. MEMBER / MANAGER
The Registrar requires all of the information below for each
member (if the applicant is a member-managed LLC) or each manager
(if the applicant is a manager-managed LLC) 1. Name as it appears
on your government-Issued ID
2. Title/Position (“Member” or “Manager”) 3. Ownership % 4. Date
of Birth (MM/DD/YYYY)
5. Identification No. (Driver’s License or Government ID No.) 6.
Social Security Number 7. Are you a U.S. Citizen?
8. Business or Residential Address City State Zip Code
9. Mailing Address (If different than business or
residential
address)
City State Zip Code
10. Phone Number 11. Email Address
CONSENT Enter [Email / Telephone]
12. I consent to receive notifications from the Registrar by
email atthe following email address
......................................................................................................
13. I consent to receive notifications from the Registrar by
textmessaging at the following telephone number
.....................................................
“Notifications” include renewal notices and monthly newsletters. By
consenting to receive notifications viatext or email, you will not
be excluded from receiving notifications by regular mail. You
consent by entering the information above.
MEMBER / MANAGER The Registrar requires all of the information
below for each member (if the applicant is a member-managed LLC) or
each manager (if the applicant is a manager-managed LLC). 1. Name
as it appears on your government-Issued ID
2. Title/Position (“Member” or “Manager”) 3. Ownership % 4. Date
of Birth (MM/DD/YYYY)
5. Identification No. (Driver’s License or Government ID No.) 6.
Social Security Number 7. Are you a U.S. Citizen?
8. Business or Residential Address City State Zip Code
9. Mailing Address (If different than business or
residential
address)
City State Zip Code
10. Phone Number 11. Email Address
CONSENT Enter [Email / Telephone]
12. I consent to receive notifications from the Registrarby
email at the following email address
.............................................
http://www.roc.az.gov/
-
1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ●
www.roc.az.gov
License Application (LLC) Form RC-L-200B Rev. December 23, 2020
Page 7 of 11
13. I consent to receive notifications from the Registrarby text
messaging at the following telephone number ....... “Notifications”
include renewal notices and monthly newsletters. By consenting to
receive notifications viatext or email, you will not be excluded
from receiving notifications by regular mail. You consent by
entering the information above.
MEMBER / MANAGER The Registrar requires all of the information
below for each member (if the applicant is a member-managed LLC) or
each manager (if the applicant is a manager-managed LLC) 1. Name as
it appears on your government-Issued ID
2. Title/Position (“Member” or “Manager”) 3. Ownership % 4. Date
of Birth (MM/DD/YYYY)
5. Identification No. (Driver’s License or Government ID No.) 6.
Social Security Number 7. Are you a U.S. Citizen?
8. Business or Residential Address City State Zip Code
9. Mailing Address (If different than business or
residential
address)
City State Zip Code
10. Phone Number 11. Email Address
CONSENT Enter [Email / Telephone]
12. I consent to receive notifications from the Registrarby
email at the following email address
.............................................
13. I consent to receive notifications from the Registrarby text
messaging at the following telephone number ....... “Notifications”
include renewal notices and monthly newsletters. By consenting to
receive notifications viatext or email, you will not be excluded
from receiving notifications by regular mail. You consent by
entering the information above.
MEMBER / MANAGER The Registrar requires all of the information
below for each member (if the applicant is a member-managed LLC) or
each manager (if the applicant is a manager-managed LLC) 1. Name as
it appears on your government-Issued ID
2. Title/Position (“Member” or “Manager”) 3. Ownership % 4. Date
of Birth (MM/DD/YYYY)
5. Identification No. (Driver’s License or Government ID No.) 6.
Social Security Number 7. Are you a U.S. Citizen?
8. Business or Residential Address City State Zip Code
9. Mailing Address (If different than business or
residential
address)
City State Zip Code
http://www.roc.az.gov/
-
1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ●
www.roc.az.gov
License Application (LLC) Form RC-L-200B Rev. December 23, 2020
Page 8 of 11
10. Phone Number 11. Email Address
CONSENT Enter [Email / Telephone]
12. I consent to receive notifications from the Registrarby
email at the following email address
..........................................
13. I consent to receive notifications from the Registrarby text
messaging at the following telephone number .... “Notifications”
include renewal notices and monthly newsletters. By consenting to
receive notifications viatext or email, you will not be excluded
from receiving notifications by regular mail. You consent by
entering the information above.
http://www.roc.az.gov/
-
1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ●
www.roc.az.gov
License Application (LLC) Form RC-L-200B Rev. December 23, 2020
Page 9 of 11
PART 4: DISCLOSURES
• PRIOR LICENSE INFORMATION Circle One 1. Has the Qualifying
Party ever been named on a license in any state that was revokedor
is currently suspended? Failure to accurately answer this question
may be a material misrepresentation of fact and a violation of
A.R.S. § 32-1154(A)(5).
(Yes) (No)
2. Has any individual listed in Part 3: Persons of this
application ever been named on alicense in any state that was
revoked or is currently suspended? Failure to accurately answer
this question may be a material misrepresentation of fact and a
violation of A.R.S. § 32-1154(A)(5).
(Yes) (No)
FELONY CHARGES Answering ‘yes’ does not automatically disqualify
the Applicant from receiving a contractor’s license. Circle One 3.
Has the Qualifying Party listed in Part 2 ever been convicted of a
felony? If ‘yes’ is selected, the Qualifying Party must complete
and attach the Felony Disclosure Form with this application.
(Yes) (No)
4. Does the Qualifying Party listed in Part 2 have a pending
felony charge that has notyet received a disposition? If ‘yes’ is
selected, the Qualifying Party must complete and attach the Felony
Disclosure Form with this application.
(Yes) (No)
5. Has any individual listed in Part 3: Persons of this
application ever been convicted ofa felony? If ‘yes’ is selected,
that individual must complete and attach the Felony Disclosure Form
with this application.
(Yes) (No)
6. Does any individual listed in Part 3: Persons of this
application have a pending felonycharge that has not yet received a
disposition? If ‘yes’ is selected, that individual must complete
and attach the Felony Disclosure Form with this application.
(Yes) (No)
UNLICENSED ACTIVITY Circle One
7. Has the Qualifying Party listed in Part 2 ever received a
citation for, or been convictedof, contracting without a license in
any state? If ‘yes’ is selected, the Qualifying Party must complete
and attach the Unlicensed Activity Disclosure Form with this
application.
(Yes) (No)
8. Has any individual listed in Part 3: Persons of this
application ever received a citationfor, or been convicted of,
contracting without a license in any state? If ‘yes’ is selected,
that individual must complete and attach the Unlicensed Activity
Disclosure Form with this application.
(Yes) (No)
http://www.roc.az.gov/https://roc.az.gov/sites/default/files/files/RC-L-202A%20-%20Felony%20Disclosure%20Form.pdfhttps://roc.az.gov/sites/default/files/files/RC-L-202A%20-%20Felony%20Disclosure%20Form.pdfhttps://roc.az.gov/sites/default/files/files/RC-L-202A%20-%20Felony%20Disclosure%20Form.pdfhttps://roc.az.gov/sites/default/files/files/RC-L-202A%20-%20Felony%20Disclosure%20Form.pdfhttps://roc.az.gov/sites/default/files/files/RC-L-202A%20-%20Felony%20Disclosure%20Form.pdfhttps://roc.az.gov/sites/default/files/files/RC-L-202C%20-%20Unlicensed%20Activity%20Disclosure%20Form.pdfhttps://roc.az.gov/sites/default/files/files/RC-L-202C%20-%20Unlicensed%20Activity%20Disclosure%20Form.pdf
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1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ●
www.roc.az.gov
License Application (LLC) Form RC-L-200B Rev. December 23, 2020
Page 10 of 11
PART 5: REQUIRED DOCUMENTS Before you submit your application,
please review the following checklist. Missing
documents will delay the processing of your application.
Review the License Application and ensure that it contains the
following:
Exam Results. The Qualifying Party’s original exam results, or a
Completed Waiver Form. Background Checks. Copies of the payment
transaction receipt from the background check for
every individual named in Part 3: Persons and the Qualifying
Party.
Bond. Completed original Bond Verification Form. Fees. The
required application fee, licensing fee and for dual or residential
licenses also include
the recovery fund assessment
Government-Issued Identification. The Qualifying Party listed in
Part 2, and each individual listed inPart 3: Persons in this
License Application must submit a legible copy of a government
issuedphoto identification with the application. Acceptable forms
of identification include a valid driver’slicense or passport.
Signatures. Completed Signatures section (see next page).
SUPPLEMENTAL DOCUMENTS – Attach the following documents if
necessary.
Additional Part 2s: If there is insufficient space to enter all
of the required information in Part 2 ofthis application, print
out, complete, and attach additional Part 3s to your
application.
Additional Part 3s: If there is insufficient space to enter all
of the required information in Part 3 ofthis application, print
out, complete, and attach additional Part 3s to your
application.
License Cancellation Form. If you currently have a license that
you wish to cancel upon theissuance of a new license, complete and
attach a License Cancellation Form.
Felony Disclosure Forms. If ‘yes’ is selected for any of the
Felony Charges questions under, Part 4,attach signed and completed
Felony Disclosure Forms and supporting documentation.
Unlicensed Activity Disclosure Forms. If ‘yes’ is selected for
any of the Unlicensed Activityquestions under Part 4, attach signed
and completed Unlicensed Activity Disclosure Forms anddocumentation
of remedial measures.
Solar Warranty. A copy of the solar warranty (if applying for a
solar license)
http://www.roc.az.gov/https://roc.az.gov/sites/default/files/files/RC-L-200G%20-%20License%20Waiver%20Request%20Form.pdfhttps://roc.az.gov/background-checkshttps://roc.az.gov/bond-information/https://roc.az.gov/license-feeshttps://roc.az.gov/license-feeshttps://roc.az.gov/sites/default/files/files/RC-L-201A%20-%20License%20Cancellation%20Form.pdfhttps://roc.az.gov/sites/default/files/files/RC-L-202A%20-%20Felony%20Disclosure%20Form.pdfhttps://roc.az.gov/sites/default/files/files/RC-L-202C%20-%20Unlicensed%20Activity%20Disclosure%20Form.pdf
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1700 W. Washington Street, Suite 105 ● Phoenix AZ 85007-2812
602.542.1525 ● Within AZ 877.692.9762 ● Fax 602.542.1599 ●
www.roc.az.gov
License Application (LLC) Form RC-L-200B Rev. December 23, 2020
Page 11 of 11
PART 6: SIGNATURES By signing below, each person certifies that
the entire contents of this License Application Form, including all
supplementary statements and materials attached, are true and
correct, and that this application is not submitted with the intent
to evade Chapter 10, Title 32 of the Arizona Revised Statutes.
A.R.S. § 32-1154(A)(9). It is a violation of A.R.S. § 32-1154(A)(5)
to make a misrepresentation of a material fact in obtaining a
license.
Applicant
The authorized representative listed in Part 1: Applicant
Information must sign this application.
_____________________ _____________________ ______________ Print
Name Signature Date
Qualifying Party The Qualifying Party listed under Part 2:
Qualifying Party must sign this application, even if they already
signed above.
_____________________ _____________________ ______________ Print
Name Signature Date
Persons Every person listed under Part 3: Persons must sign this
application, even if they already signed above. If you need
additional space for signatures, complete and attach additional
signature pages with your application.
_____________________ _____________________
_____________________ Print Name Signature Date
_____________________ _____________________
_____________________ Print Name Signature Date
_____________________ _____________________
_____________________ Print Name Signature Date
_____________________ _____________________
_____________________ Print Name Signature Date
_____________________ _____________________
_____________________ Print Name Signature Date
http://www.roc.az.gov/
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LICENSE BOND
THIS BOND MUST BE ON FILE WITH THE ARIZONA REGISTRAR OF
CONTRACTORS
STATE OF ARIZONA REGISTRAR OF CONTRACTORS
BOND NO:
That
______________________________________________________________________________________________________
as the principal, and
_______________________________________________________________________________________
(Surety)
a corporation, duly authorized and licensed to transact surety
business in the State of Arizona, are held and firmly bound unto
the State of Arizona for the benefit of those persons described in
A.R.S. §32-1152, as amended, in the penal sum set forth for the
classification of license described:
LICENSE CLASSIFICATION PENAL SUM
The Principal has applied to the Registrar of Contractors of the
State of Arizona for a license to conduct the business of
contracting under the above-described classifications and submits
this bond to comply with the provisions of A.R.S. §32-1152, as
amended, which are incorporated herein as though fully set
forth.
Liability under this bond is limited to the penal sum for each
classification of work performed by the principal. Liability under
each classification shall be determined strictly in accordance with
the provisions of A.R.S. §32-1152, as amended, which are
incorporated herein as though fully set forth.
Upon making payment to a claimant against the bond, the Surety
shall immediately give written notice to the Principal and the
Registrar of Contractors of the date and amount of payment.
The amount of this bond is based on the representation of the
Principal of the anticipated annual gross volume of work pursuant
to Rule R4-9-112.
This bond becomes effective on day of , 20 .
SIGNED, SEALED AND DATED day of , 20 .
By: Signature of Contractor (Principal) Signature
Attorney-In-Fact (Must be Notarized)
By: Title of Signer Print or Type Name of Attorney-In-Fact
Subscribed and sworn to before me this ______________
Print or Type Name of Contractor (Principal) day of
__________________, 20____________.
THE ORIGINAL BOND MUST BE SIGNED BY THE PRINCIPAL,
ATTORNEY-IN-FACT AND THE NOTARY PUBLIC AND BE FILED WITH THE
REGISTRAR OF CONTRACTORS AT: 1700 W. Washington St. Ste. 105,
PHOENIX, AZ 85007-2812, TO COMPLY WITH A.R.S. § 32-1152 Mail to:
P.O. Box 6688, Phoenix, AZ 85005-6688
Notary Public
My Commission Expires:
State of:
County of:
RC-L-220D 7/12
RC-L-200B-License Application-LLC 20200804Rc-l-220D Bond
FormSTATE OF ARIZONA Subscribed and sworn to before me this
______________Print or Type Name of Contractor (Principal) day of
__________________, 20____________. Notary Public
My Commission Expires: State of:
1 Limited Liability Company Name: 2 Fictitious Trade Name ie DBA
if applicable: 3 Authorized Representative s Name: 4 Arizona
Corporation Commission File Number: 5 Requested License
Classification Description: 6 Business Address No PO Boxes or
Private Mail Boxes: City: State: Zip Code: 7 Mailing Address If
different than business address: City_2: State_2: Zip Code_2: 8
Phone Number: 9 Email Address: 10 I consent to receive
notifications from the Registrar by email at the following email
address: 11 I consent to receive notifications from the Registrar
by text messaging at the following telephone number: Policy Number:
Company Issuing Policy: 2 SelfInsured Employer You Must Submit
Documentation Showing Proof of Coverage with this Application: 3
Exemption SingleMember LLC without any employees or 5050 TwoMember
LLC without any employees: Group1: Off1 Name as it appears on your
government issued ID: 2 TitlePosition: 3 Ownership: 4 Date of Birth
MMDDYYYY: 5 Driver s License or Government ID No: 6 Social Security
Number: 7 Are you a US Citizen: 8 Residential Address: City_3:
State_3: Zip Code_3: 9 Mailing Address If different than
residential address: City_4: State_4: Zip Code_4: 10 Phone Number:
11 Email Address: Enter Email Telephone12 I consent to receive
notifications from the Registrar by email at the following email
address: Enter Email Telephone13 I consent to receive notifications
from the Registrar by text messaging at the following telephone
number: 1 Business Name of Employer or SelfEmployed: 2 Duration of
Experience eg 112007 through 112017: 3 Average Hours Worked Per
Week: 4 Positions: 5 Size of Projects Qualifying Party Worked On
Square Foot andor Dollar Amount: 6 Description of Qualifying Party
s Main Duties: 7 References Name: 8 Reference s Relationship to
Qualifying Party eg Coworker Employer Supervisor: 9 References
Mailing Address: City_5: State_5: Zip Code_5: 10 References Phone
Number: 11 References Email: 1 Business Name of Employer or
SelfEmployed_2: 2 Duration of Experience eg 112007 through
112017_2: 3 Average Hours Worked Per Week_2: 4 Positions_2: 5 Size
of Projects Qualifying Party Worked On Square Foot andor Dollar
Amount_2: 6 Description of Qualifying Party s Main Duties_2: 7
References Name_2: 8 Reference s Relationship to Qualifying Party
eg Coworker Employer Supervisor_2: 9 References Mailing Address_2:
City_6: State_6: Zip Code_6: 10 References Phone Number_2: 11
References Email_2: 1 Name as it appears on your governmentIssued
ID: 2 TitlePosition Member or Manager: 3 Ownership_2: 4 Date of
Birth MMDDYYYY_2: 5 Identification No Driver s License or
Government ID No: 6 Social Security Number_2: 7 Are you a US
Citizen_2: 8 Business or Residential Address: City_7: State_7: Zip
Code_7: 9 Mailing Address If different than business or residential
address: City_8: State_8: Zip Code_8: 10 Phone Number_2: 11 Email
Address_2: Enter Email Telephone12 I consent to receive
notifications from the Registrar by email at the following email
address_2: Enter Email Telephone13 I consent to receive
notifications from the Registrar by text messaging at the following
telephone number_2: Check Box2: OffCheck Box3: Off1 Name as it
appears on your governmentIssued ID_2: 2 TitlePosition Member or
Manager_2: 3 Ownership_3: 4 Date of Birth MMDDYYYY_3: 5
Identification No Driver s License or Government ID No_2: 6 Social
Security Number_3: 7 Are you a US Citizen_3: 8 Business or
Residential Address_2: City_9: State_9: Zip Code_9: 9 Mailing
Address If different than business or residential address_2:
City_10: State_10: Zip Code_10: 10 Phone Number_3: 11 Email
Address_3: Enter Email Telephone12 I consent to receive
notifications from the Registrar by email at the following email
address_3: Enter Email Telephone13 I consent to receive
notifications from the Registrar by text messaging at the following
telephone number_3: 1 Name as it appears on your governmentIssued
ID_3: 2 TitlePosition Member or Manager_3: 3 Ownership_4: 4 Date of
Birth MMDDYYYY_4: 5 Identification No Driver s License or
Government ID No_3: 6 Social Security Number_4: 7 Are you a US
Citizen_4: 8 Business or Residential Address_3: City_11: State_11:
Zip Code_11: 9 Mailing Address If different than business or
residential address_3: City_12: State_12: Zip Code_12: 10 Phone
Number_4: 11 Email Address_4: Enter Email Telephone12 I consent to
receive notifications from the Registrar by email at the following
email address_4: 13 I consent to receive notifications from the
Registrar by text messaging at the following telephone number: 1
Name as it appears on your governmentIssued ID_4: 2 TitlePosition
Member or Manager_4: 3 Ownership_5: 4 Date of Birth MMDDYYYY_5: 5
Identification No Driver s License or Government ID No_4: 6 Social
Security Number_5: 7 Are you a US Citizen_5: 8 Business or
Residential Address_4: City_13: State_13: Zip Code_13: 9 Mailing
Address If different than business or residential address_4:
City_14: State_14: Zip Code_14: 10 Phone Number_5: 11 Email
Address_5: Enter Email Telephone12 I consent to receive
notifications from the Registrar by email at the following email
address_5: Enter Email Telephone13 I consent to receive
notifications from the Registrar by text messaging at the following
telephone number_4: 1 Name as it appears on your governmentIssued
ID_5: 2 TitlePosition Member or Manager_5: 3 Ownership_6: 4 Date of
Birth MMDDYYYY_6: 5 Identification No Driver s License or
Government ID No_5: 6 Social Security Number_6: 7 Are you a US
Citizen_6: 8 Business or Residential Address_5: City_15: State_15:
Zip Code_15: 9 Mailing Address If different than business or
residential address_5: City_16: State_16: Zip Code_16: 10 Phone
Number_6: 11 Email Address_6: Enter Email Telephone12 I consent to
receive notifications from the Registrar by email at the following
email address_6: Enter Email Telephone13 I consent to receive
notifications from the Registrar by text messaging at the following
telephone number_5: Check Box4: OffCheck Box5: OffCheck Box6:
OffCheck Box7: OffCheck Box8: OffCheck Box9: OffCheck Box10:
OffCheck Box11: OffCheck Box12: OffCheck Box13: OffCheck Box14:
OffCheck Box15: OffPrint Name: Date: Print Name_2: Date_2: Print
Name_3: Print Name_4: Print Name_5: Print Name_6: Print Name_7:
Date_3: Date_4: Date_5: Date_6: Date_7: BOND NO: That: as the
principal and: LICENSE CLASSIFICATION 1: LICENSE CLASSIFICATION 2:
LICENSE CLASSIFICATION 3: PENAL SUM 1: PENAL SUM 2: PENAL SUM 3:
This bond becomes effective on: day of: 20: SIGNED SEALED AND
DATED: day of_2: Title of Signer: Print or Type Name of Contractor
Principal: 20_2: By_2: Subscribed and sworn to before me this: day
of 1: day of 2: 20_3: My Commission Expires: State of: County
of: