Office Use Only: Contractor’s License #: Receipt#: $25.00 Issued: Town of Cowley PO BOX 635 COWLEY, WY 82420 Phone: (307)-548-7700 FAX: (307)-548-6360 APPLICATION FOR 2022 BUILDING CONTRACTOR’S REGISTRATION Business Name: Physical Address: City State Zip Mailing Address: City State Zip Social Security Number or Employer Identification Number: Driver’s License Number: Issuing State: Liability Insurance Provider: Policy#: *Please provide the Town of Cowley with a copy of your insurance policy Will you be using: Employees Sub-Contractors or Working Alone ALL CONTRACTORS, INCLUDING SOLE PROPRIETORS, MUST HAVE LIABILITY INSURANCE Type of work to be performed under the license: How long engaged in such work and specify full-time or part-time: List all other names under which you have done business in the last five (5) years: List all litigation if any you or your business (any former names included) have been involved in: Telephone Number: Business Residence/Primary When any excavation is performed, I (the above contractor) will restore all such streets to their original condition after repair work or said pipes, main or conduits have been laid or re-laid as the case may be at my exclusive expense and without charge to the Town. If, at the sole discretion of the Mayor and the Town Council, the said streets or other public property, have not been repaired and restored within a time that said Mayor and Town Council deems responsible, then the Town shall repair and restore or cause the same to be repaired and restored, and I will pay the Town for all costs and expenses in repairing and restoring of said streets and public property. Name Date |
(Ord. 323, 2022, passed 1-11-2022)