Form 309-6701 - Contractor Registration Application/renewal Form/form 60-0126 - Report To Determine Liability

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Contractor Registration Application/Renewal Form
For Office Use Only
Iowa Division of Labor Services
Iowa Unemployment Account#
1000 East Grand Avenue, Des Moines, Iowa 50319-0209
Telephone (515) 242-5871 or 1-800-562-4692, Ext. 25871
Fax (515) 725-2427
Contractor Registration#
E-Mail: contractor.registration@iwd.iowa.gov
309-6701 (07-12)
Check#
All "construction" contractors doing business in Iowa who make more than $2,000 a year must be registered with the Iowa
Division of Labor. "Construction" is defined very broadly to include not only typical "construction" work, but also companies or
individuals who perform electrical, plumbing, roofing, or house painting work, as well as installation of landscaping, windows,
cable, elevators, and many other activities. You must renew your registration every year. You may be eligible for a waiver of
the $50 registration fee as outlined on page 2. If a contractor does business under more than one name, each name must
be individually registered. Out-of-state contractors must file a $25,000 surety bond with the Iowa Division of Labor, at the time of
registration and renewing. Visit for a bond information and a copy of the form.
Instructions For New Contractor Application/Renewal Form
(all fields must be completed)
1. Please copy your completed form for your files before returning it to the Iowa Division of Labor. Return the completed
1.
application (page 1 and 2), report to determine lability form, workers' compensation certificate, and the $50 registration fee
1.
(Money Order or Check) payable to Iowa Division of Labor mailed to the address above.
2. The Iowa Division of Labor will mail you a contractor registration number once you are registered. Your application may take
2.
several weeks to process. You are not registered until a contractor registration number is issued.
Application Type
New
Renewal
Previous
Contractor Registration#
1. Type of Organization
Individual Ownership
Corporation
Partnership
Other:
3. Current Iowa Unemployment Number, if assigned:
2. Federal ID # (FEIN):
4. Corporate/LLC Name:
Business or Trade Name:
5. Mailing Address
City
State
Zip Code
County
P.O. Box
Physical Address:
Address
City
State
Zip Code
County
Business Telephone#:
Alternate Telephone#
Fax#:
6. List names of Owner, Partners, Members or
Social Security #:
Resident Address:
Corporate Officers:
Equal Opportunity Employer/Program
Pg. 1
****Continued on Back - Signature REQUIRED****
Auxiliary aids and services available upon request to individuals with disabilities.
For deaf and hard of hearing, use Relay 711.

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