Miami Shores Contractor registration form (1)Miami Shores Vmage
Building Department
10050 N .E .2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
CONTRACTORS' REGISTRATION
Fax: (305) 756.8972
IF CONTRACTOR IS A FLORJDA STATE CERTIFIED CONTRACTOR:
A __ COPY OF QUALIFIER 'S STATE LICENCES
8. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER fonn and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
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B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR 'S TAX RECEIPT.
D. __ COPY OF LIABILITY INSURACE *
E. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER fonn and Contractor Affidavit)
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND A VE
MIAMI SHORES, FL 33138
Certificate must specify the description of operations or contractor license number.
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BUSINESS NAME: I} / y C...o t-r~ / -/ "~ t-, / t, g p y tr> -fc... ct.,
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l CELLPHONE( __ )______ . -/
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I QUALIFIER'S LIC NUMBER: l/;:1 C I ~ 17 0 5a p L~ ~~---