Form Con - Biennial License Renewal For General Contractor - With Residential Endorsement - Alaska Department Of Community And Economic Development Page 3
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5IMPORTANT
Please read the requirements for bonding, insurance, return of cash deposits, and TCDs, in Article 2 of Alaska
Statute 08.18 and regulations 12 AAC 21.090 - .120 (see attached).
It is the contractor’s responsibility to advise this department of any and all changes regarding the bonding
and insurance.
TIME CERTIFICATE OF DEPOSIT OR CASH DEPOSIT
Contractors with a Time Certificate of Deposit or other cash deposit on file with this office, please indicate here:
TIME CERTIFICATE OF DEPOSIT
CASH DEPOSIT
TCD #
Bank
Amount $
TCD #
Bank
Amount $
SURETY BOND
If an existing surety bond is used, the licensee may complete the section below. If a new bond has been issued,
the original, signed bond, including Power of Attorney, must accompany this renewal application.
This certifies BOND #
written by
(Bonding Company)
for $
, for
(amount)
Applicant Name (owner or all partners)
d/b/a Company Name
is still in full force and effect.
GENERAL LIABILITY INSURANCE
AS 08.18.101 requires proof of general liability insurance coverage for all contractors. Please, list your public
liability and property damage insurance information below.
Name of Liability Insurance Company (not agent)
Policy Number
Issue Date
Expiration Date
WORKERS’ COMPENSATION INSURANCE
Does this business have any employees?
Yes
No
If “Yes,” I certify that I have the workers’ compensation insurance that is required by AS 08.18.101, as
described below:
Name of Workers’ Compensation Insurance Company (not agent)
Policy Number
Issue Date
Expiration Date
08-4135 (Rev. 11/02)
CONTINUED ON NEXT PAGE
Extra Handout Form -G (Internet Version)
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