Source: https://www.scribd.com/document/1720427/Department-of-Labor-eli-electrical-or-elevator-license
Timestamp: 2018-09-22 21:54:37
Document Index: 563006138

Matched Legal Cases: ['art 1', '§ 326', '§ 326', '§ 176', '§ 326', '§ 326', '§ 270', '§ 13', '§ 326', '§ 326', '§ 326', '§ 326', '§ 270', '§ 326', '§ 270', '§ 13', '§ 326', '§ 326', '§ 326', '§ 326', '§ 326', '§ 326', '§ 326', '§ 326', '§ 326', '§ 326']

Department of Labor: eli electrical or elevator license | Surety Bond | Trade Name
Department of Labor: eli electrical or elevator li...
A) City of Carmel Beach Restrooms_Project Manual-Part 1 March 2014
William Wagner and J. A. Tretheway v. Fireman's Fund Insurance Company, Flora Construction Company, Argus Construction Company, Flora Construction Company and Argus Construction Company, a Joint Venture, and Mildred L. Flora, Walter W. Flora v. Fireman's Fund Insurance Company, 352 F.2d 410, 10th Cir. (1965)
Lafayette Road North St. Paul, MN 55155-4342 Phone: (651) 284-5031 Fax: (651) 284-5743 TTY/MRS: (651) 297-4198 E-mail: DLI.License@state.mn.us www.doli.state.mn.us/license
Electrical or Elevator Renewal Checklist
License Fee $200.00, if Late an additional $100.00
Electrical/Elevator Application form, completed and signed by principal of the company or authorized representative. Must be original document. Disclosure of Business Owners, Partners, Officers and Member – Must be original document. Secretary of State (SOS) – A copy of current SOS registration which indicates certificate of good standing and/or Certificate of Assumed Name issued by the Office of the Secretary of State (SOS) (not required for an individual (sole proprietor) or partnership when the individual's and all partners' own true full names are used in the company name). SOS may be contacted at www.sos.state.mn.us or (651) 296-2803. May be a copy from the SOS website. Bond, including Power of Attorney form, signed, acknowledged (notarized) – Must be original document. Certificate of Liability Insurance, NOT on an acord form – Must be original document. Workers Compensation Certification of Compliance form – Must be original document. Responsible Licensed Individual Master Electrical/Elevator – Must be original document.
MAIL ABOVE FORMS WITH $200 LICENSE FEE TO: Minnesota Department of Labor and Industry Financial Services – Electrical 443 Lafayette Road North St. Paul, Minnesota 55155-4342
NOTE: Please make sure that the check issued for payment indicates “Electrical Contractor Fee” so that we may expedite the processing of your contractor’s license.
This material can be made available in different forms, such as large print, Braille or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or TDD (651) 297-4198. Checklist LIC 12 (1/08)
Minnesota Department of Labor and Industry Construction Codes and Licensing Division Licensing and Certification Services 443 Lafayette Road North St. Paul, MN 55155-4342 Phone: (651) 284-5031 Fax: (651) 284-5743 TTY/MRS: (651) 297-4198 E-mail: DLI.License@state.mn.us www.doli.state.mn.us/license.htlm
Instructions for Completing the Electrical/Elevator Contractor Application
Fill out the application form completely Incomplete or inaccurate application will delay processing.
Depositing of license fees does not constitute granting of the license applied for. This application will not be approved and the license applied for will not be renewed or issued unless all of the conditions identified on this application and in the M.S. §§ 326B.31 to 326B.399, M.S. §§ 326B.081 to 326B.085 and Minnesota Rules, Chapter 3800 are in compliance. Checks returned for nonpayment will be charged a $30 fee M.S. 604.113, subd. 2. Note: Minnesota Statutes Chapter 326B, sections 326B.081 to 326B.085 and Minnesota Statutes, sections 326B.31 to 326B.399 as found in Minnesota Session Laws, 2007, Chapter 140.
Make check payable to: Department of Labor and Industry
The box numbers on the application correspond with the numbered items in the following instructions. 1. You must register ALL business names along with the Assumed Name (dba) for your company. Please Contact Office of the Secretary of State, Minnesota State Retirement Building, 60 Empire Drive, St. Paul, MN 55103, (651) 296-2803 www.sos.state.mn.us Licenses are not processed until your business name is registered with SOS. Business type (check only one). If your business type is not listed, check "other" and write in business type (must be a recognized business type and registered with Minnesota Secretary of State (SOS) Office). Business Telephone Number Fax Number of person signing the application form. E-mail address of person signing the application form. Legal Business Name of Contractor. Except for an individual (sole proprietor) or a partnership making application using the individual's or all partners’ own full true name(s) as the contractor name, the name identified on the Certificate of Assumed Name or Certificate of Authority issued by the Office of the Secretary of State shall be used on all forms used to apply for any contractor license issued by the Department. Examples of business names: An individual without an assumed name - John Doe or John Doe Electrical/Elevator An individual using their full true name as in the example above are not required to register with the Secretary of State An individual with an assumed name - John Doe dba Assumed Name A partnership with an assumed name - John Doe and James Doe dba Assumed Name A corporation - Company Name Inc. A corporation with an assumed name – Company Name Inc. dba Assumed Name A limited liability company - Company Name, LLC or LLP Additional business, tax, and employment information can be found in a Guide to Starting a Business in Minnesota at www.deed.state.mn.us/bizdev/start.html. A copy is available without charge from the Minnesota Department of Employment and Economic Development, Small Business Assistance Office. Telephone (651)-296-3871 or 1-800-310-8323. 7. 8. 9. Doing Business As (DBA) – This part is only completed if you are an individual proprietor or a corporation using an assumed name. This is the name that would go on your license. Business Address. PO Box numbers are not acceptable. Mailing Address (if different from above). A PO Box address may be used.
10. If the electrical contracting business is conducted at locations other than the address shown under 2 or 3, list those addresses and phone numbers below. All out-of-state businesses, except those in states contiguous with Minnesota (North Dakota, South Dakota, Iowa and Wisconsin) must provide their Minnesota place of business (registered office or registered agent) and telephone number. 11. Responsible Licensed Individual: There can only be one responsible licensed person for each contractor license. You must give CCLD Licensing and Certification Services 15 days advance notice upon termination of employment. If the contractor is: An individual or sole proprietorship then the responsible licensed individual must be the individual, proprietor, or managing employee An individual partnership - the responsible licensed individual must be a general partner or managing employee A limited liability company - the responsible licensed individual must be a chief manager or managing employee A corporation - the responsible licensed individual must be an officer or managing employee. A managing employee - the responsible licensed individual must be actively engaged in performing electrical work on behalf of the contractor, and cannot be employed in any capacity as an electrician or technician by any other contractor or employer designated in subdivision 12. An individual may be the responsible licensed individual for only one contractor or employer.
Instructions LIC 12 (12/07)
12. Does the company have employees? All officers of corporations are employees under the Workers’ Compensation Law except for closely held corporations meeting the requirements of M.S. § 176.012 Please complete the enclosed Workers’ Compensation Insurance Form and submit it with the contractor license application forms. Workers’ Compensation insurance policy number can not be in pending status. The State Unemployment Insurance Account Number is generally not issued until the first payroll report is filed with Economic Security. 13. Except for individual (sole proprietor) or one-member limited liability companies without employees or taxable sales, all companies must furnish their business Federal Employer Identification Number and Minnesota Identification Number. Tax numbers are available from the state or federal revenue agencies. Their telephone numbers are: Minnesota Identification Number (651) 282-5225 Federal Employer Identification Number 1-800-829-4933 Economic Security (Unemployment Insurance) (651) 296-6141 Labor and Industry (Workers’ Comp Inc.) (651) 284-5005 0r 1-800-342-5354 Revenue (if making retail sales in MN) (651) 296-6181 – Corporate and Sales Tax Division 14. Write in the name of your Bonding Company and submit the $25,000.00 Electrical or Elevator Contractor Bond form and Power of Attorney form with the application. The original Bond and Power of Attorney form must be submitted. Photocopies are not acceptable. 15. Write in the name of your Insurance Company, policy number and expiration date of policy and submit the Certificate of Insurance with the application. A policy number must be on the certificate of insurance. No policy number pending status. An original Certificate of Insurance form must be submitted. Photocopies and faxes are not acceptable. Acord language is not acceptable. 16. Sign and date Electrical/ application form. This application must be signed by one of the listed on the attached Disclosure of Business Owners, Partners, Officers and Members form. Note: If the company is a partnership or a limited liability partnership, all partners and members must sign the application. NOTE: The Department may revoke, suspend or refuse to issue any license granted pursuant to M.S. § 326B.082, subd. 12 when the licensee knowingly and willfully makes a false statement in any license application. There must be no outstanding “Orders for Payment,” unfilled “Requests for Inspection” or other violations of M.S. § 326B.36, to be considered in compliance. Sign and date the application form. If the company is a partnership or a limited liability partnership, all partners and members must sign the application.
PRINT IN INK or TYPE. Unreadable or illegible applications will be denied. Date Stamp
Application for Electrical/Elevator Contractor License
For the period March 1, 2008 through February 28, 2010
Renewal New Business Structure Change
Contractor License Number (if applicable) SPACE IN BOX FOR OFFICE USE ONLY
Date Pd License # Amt Pd Late Fee Pd Interagency Pymt Check # Source Code
The information you provide on this application will be used to determine if you meet the license requirements. Before a license is issued to you, M.S. § 270C.72, subd 4, requires you to provide your social security number. The other information is required to process your application. Failure to provide the requested information may delay the processing of your application or may be grounds for denying your application. Under M.S. § 13.41, the information that you provide on this application, except for your name, and address is private data while the application is pending. Disclosure of this information to others may occur as authorized or required by law, including the Attorney General’s Office, the Department of Revenue, the Department of Human Services, and/or for the purpose of verification and investigation. Once you are licensed, the information becomes public data (except for social security numbers) and will be part of the agency’s permanent records.
Late fee: $100 if not renewed 30 days after expiration Prorated license fee schedule for a new license New Licenses issued: 3/1/08 thru 2/28/09 $200 3/1/09 thru 2/28/10 $100
Depositing of license fees does not constitute granting of the license applied for. This application will not be approved and the license applied for will not be renewed or issued unless all of the conditions identified on this application and in the M.S. §§ 326.01 and 326.241-248 and Minn. Rules, Chapter 3800 are complied with. Checks returned for nonpayment will be charged a $30 fee (M.S. 604.113, subd. 2.
1. MINNESOTA SECRETARY OF STATE (SOS) REGISTRATION: Is your business name(s) registered with SOS? Yes No. Except when an individual or partnership is doing business under their own true full legal first and last name(s). All businesses and assumed names (dba) must be registered with the Office of the Secretary of State, Minnesota State Retirement Building, 60 Empire Drive, St. Paul, MN 55103, (651) 296-2803, www.sos.state.mn.us. Licenses are not processed until your business name is registered with SOS. Attach a copy of ALL current year’s filing with SOS. (Note: You must register your business name yearly with SOS, however, an assumed name must be renewed every 10 years. Please contact SOS for further information.) 2. BUSINESS TYPE
Limited Liability Company Limited Liability Partnership Other State business is organized in: 5. E-MAIL ADDRESS
4. FAX TELEPHONE NUMBER
6. LEGAL BUSINESS NAME OF CONTRACTOR Individual name only if no company name used - See instructions
7. DBA (doing business as name) (if applicable)
9. MAILING ADDRESS (if different from above)
THE SECOND PAGE MUST BE COMPLETED
FOR OFFICE USE ONLY WC INS SOS EMPLOYMENT APPLICATION MASTER LIC OFFICER CONTRACTOR LIC # BOND EFFECTIVE DATE LIABILITY INS APPROVED BY
LIC 12 (12/07)
10. If Electrical/Elevator contracting business is conducted at locations other than the address shown under #8 or #9, list address and phone number below. Out of state businesses, except states contiguous with Minnesota, must provide their Minnesota place of business and telephone number. STREET ADDRESS CITY STATE ZIP CODE PHONE NUMBER (area code)
11. Responsible Licensed Individual (Managing Employee): This is to certify that I am or have in my employ a responsible licensed person who will be actively responsible for the performance of all electrical work, including planning, laying out and supervising installation of all such work, in accordance with the requirements of M.S. §§ 326B.01 and 326B.241-248 and Minn. Rules Chapter 3800. (See instruction sheet for clarification regarding managing employee.) LAST NAME FIRST NAME MI TITLE MASTER LIC # EXPIRATION DATE
12. Do you have employees? Yes No. (The responsible licensed person listed under #11 is an employee unless s/he is the owner, an officer, member, or partner) You must also complete the workers comp insurance form enclosed with this packet. WORKERS’ COMP INS POLICY # INSURANCE COMPANY NAME STATE UNEMPLOYMENT INS ACCT #
13. The following information must be provided unless the applicant is an individual (sole proprietor) or one-member limited liability company and does not have employees or taxable sales: (See the application instructions if the company is from outside of Minnesota and is not required to withhold Minnesota income taxes.) FEDERAL EMPLOYER TAX NO (FEIN) (if applicable) MINNESOTA TAX NO (MN ID) (if applicable)
14. Name of Bonding Company ($25,000.00 performance bond attached) BONDING COMPANY NAME BOND NUMBER
15. Name of Insurance Company (Certificate of Insurance showing evidence of general liability insurance in the amounts required under M.S. § 326.242, subd 6(b) attached). NAME OF INSURANCE COMPANY POLICY NUMBER EXPIRATION DATE
16. This is to certify that the company making this application is in compliance with the provisions of M.S. §§ 326.01 and 326.241-248 and Minn. Rules, Chapter 3800, including: (a) Compensation of any employee doing electrical work will be reported on an Internal Revenue Service W-2 form. (b) Where required, all electrical work will be performed by, or under the personal on-the-job supervision of properly licensed or registered unlicensed persons. One licensed person shall supervise no more unlicensed persons than allowed by M.S. 326.242, subd. 5. (c) All advertising and business forms will be in the name shown on my contractor's license. (d) I will immediately notify the Department in writing of any change of address, telephone number, change of business structure, change of responsible master, employment of others, or other information required on my application. I hereby declare that any statements herein are true and complete, with the same force and effect as though given under oath. One of the officers listed on the attached Disclosure of Business Owners, Partnership, Officers and Members form. If partnership then all partners must sign below: APPLICANT SIGNATURE (Owner, Partner, Member, President, Vice President) TITLE DATE OF APPLICATION
Instructions for Completing the Disclosure of Business Owners, Partners, Officers and Members
List the principals of the company; Owner, all Partners of partnerships, all Officers of corporations, all Partners of limited liability partnerships, all Limited Liability Company Members, and all Principals of other business types.
1. 2. 3. Complete the legal business name, address and telephone number. Complete name, percentage of ownership, social security number, residential address and telephone number of all owners, officers, partners or members. Each person listed must sign this form. May use separate form for each person.
Instructions LIC 09 (12/07)
Minnesota Department of Labor and Industry Construction Codes and Licensing Division Licensing and Certification Services 443 Lafayette Road North St. Paul, MN 55155-4342 Phone: (651) 284-5031 Fax: (651) 284-5743 TTY/MRS: (651) 297-4198
This form must be completed for all business types.
Minnesota Statutes § 270C.72, Tax Clearance; Issuance of Licenses, requires the Department of Labor and Industry to require contractor license applicants to provide their Minnesota Identification Number and the social security numbers of all individual owners, partners, officers, and members of the business entity. The Department of Revenue may order the Department to revoke or not issue the license of any applicant who has not filed tax returns or is delinquent in paying taxes. An individual’s social security number is classified as private data and will only be supplied to the Minnesota Department of Revenue, which may supply this information to the Internal Revenue Service, or may occur as authorized or required by law. Failure to supply the required information may delay or prevent the Department from processing the original or renewal application. If the business is an Individual, partnership, corporation, foreign corporation or a limited liability company, the names, addresses, social security numbers, and signatures of all additional owners, partners, officers, or members must be completed on this form. Please copy this form if you need additional space.
LEGAL BUSINESS NAME OF CONTRACTOR Individual name only if no company name used - See instructions
LIST ALL Owners, Officers, Partners, or Members
LAST NAME FIRST NAME MI % OF OWNERSHIP SOCIAL SECURITY NO (mandatory)
TITLE (owner, partner, officer or member, etc.)
SOCIAL SECURITY NO (mandatory)
This material can be made available in different forms, such as large print, Braille or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or TDD (651) 297-4198. LIC 09a (12/07)
Instructions for Completing Electrical/Elevator Contractor Bond
THE ORIGINAL BOND FORM MUST BE FILED WITH THE APPLICATION – COPIES WILL NOT BE ACCEPTED. The Surety Company may use its own form. Regardless of whether the Department’s bond form is used or whether the Surety Company uses their own form, the expiration date for an Electrical or Elevator Contractor Bond must be March 1, 2010. The bond shall be effective and run concurrently with the license period from the date the license is granted and shall expire on March 1, 2010. When the Department supplied bond form is used, it must be completed as follows: (Surety Company provided bond forms are completed in a similar manner with the same language that is on the Departments Bond form). Bond number: The Bond number must be issued. It cannot be marked "pending." The Business name including the assumed name (doing business as (dba)) shall be exactly the same as the applicant used on their "Electrical or Elevator Bond Registration Form” and all other forms. The business name that an applicant uses to identify themselves must be filed or registered with the Office of the Secretary of State. Note: Only individual (sole proprietor) or partnership business types using their own true full name(s) of the individual or all partners as part of the business name are not required to be registered with the Office of the Secretary of State. See below examples: An individual without an assumed name - John Doe or John Doe Electrical An individual using their full true name as in the example above are not required to register with the Secretary of State An individual with an assumed name - John Doe dba Assumed Name A partnership with an assumed name - John Doe and James Doe dba Assumed Name A corporation - Company Name Inc. A corporation with an assumed name - Company Name Inc. dba Assumed Name A limited liability company - Company Name, LLC or LLP The address of the Business. The name of the Surety (Bonding) Company. The surety company’s address and telephone number. The state that the Surety Company is organized in. The date the Bond was signed and surety sealed by the power of attorney. Signature of Principal. If the Business is an individual owner, the owner must sign bond; if a partnership, all partners must sign bond; if a limited liability partnership, all partners must sign bond; if a corporation, an officer must sign bond; and if another business entity, a person with delegated authority must sign bond. The individual(s) signing the bond for the business must be identified as the Owners, all Partners of partnerships, all Officers of corporations (Inc), all Partners of limited liability partnerships (LLP) , all Limited Liability Company Members (LLC), and all Principals of other business types as listed on the Electrical or Elevator Bond Registration Form. Name of Surety (Bonding) Company. Signature of Attorney in Fact (Surety Company). VERY IMPORTANT! The bond form must be notarized as follows: (A) or (B) AND (C) below A. If the business is an Individual, Partnership, or a Limited Liability Company, the bond form must be notarized in the block on the upper one-third of the form. ALL SIGNATURES NEED TO BE NOTARIZED. B. If the business is a Corporation, the bond form must be notarized in the block in the center one-third of the form. C. The block in the lower one-third of the form must be notarized by the Surety company. The original Power of Attorney form must be attached.
This material can be made available in different forms, such as large print, Braille or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or TDD (651) 297-4198. Instructions LIC BD 08 (12/07)
Minnesota Department of Labor and Industry Construction Codes and Licensing Division Licensing and Certification Services 443 Lafayette Road North St. Paul, MN 55155-4342 Phone: (651) 284-5031 Fax: (651) 284-5743 TTY/MRS: (651) 297-4198 E-mail: DLI.License@state.mn.us www.doli.state.mn.us/license.html
TWENTY FIVE THOUSAND DOLLARS ($25,000) for the benefit of persons injured or suffering financial
loss by reason of failure of such performance as herein specified for the payment of which, we bind ourselves, our heirs, executors, administrators, successors and assigns firmly by these presents. The bond shall be filed with the Minnesota Department of Labor & Industry and shall be in lieu of all other license bonds to any other political subdivision as provided in M.S. § 326B.33, subd. 6a. The condition of the above obligation is such, that whereas, the said Principal is licensed as an Electrical or Elevator Contractor. This bond shall constitute a new obligation in the sum of $25,000 for each biennial license period for which the Principal is licensed, provided, however, that the aggregate liability for the Surety to all persons for any one biennial license period shall in no event exceed the sum of $25,000. NOW THEREFORE, the condition of this obligation is that the Principal shall faithfully and lawfully perform all work entered upon by him as a Electrical or Elevator contractor within the state of Minnesota, then this obligation to be void; otherwise to remain in full force and effect. This bond shall be effective and run concurrently with the period of the aforesaid license from the date said license is granted in the current year which shall expire on March 1, 2010. During the term of this obligation the principal and surety will pay unto the obligee or as otherwise directed by the obligee the amount needed to correct non-complying work. The aggregate liability of the surety hereunder pertains to all claims arising during the period as defined above and shall in no event exceed the total sum of TWENTY-FIVE
LIC BD 08 (12/07)
Liability Insurance Coverage This is to certify that the insurance policy listed below has been issued to the named insured for the policy period indicated and that the policy meets the minimum coverage requirements applicable under Minnesota Statutes, section 326.242, Subd. 6b.
Electrical or Elevator Contractor
Policy provides general liability insurance (including premises and operations insurance and products and completed operations insurance) with limits of at least $100,000 per occurrence, $300,000 aggregate limit ZIP CODE for bodily injury, and property damage insurance with limits of at least $50,000; or a policy with a single limit for bodily injury and property damage of $300,000 per occurrence and $300,000 aggregate limits.
LIC-01K (12/07)
Minnesota Department of Labor and Industry Construction Codes and Licensing Division Licensing and Certification Services 443 Lafayette Road North St. Paul, MN 55155-4342 Phone: (651) 284-5080 Fax: (651) 284-5743 TTY/MRS: (651) 297-4198 www.doli.state.mn.us/license dli.license@state.mn.us PRINT IN INK or TYPE
Minnesota Statutes, Section 176.182 requires every state and local licensing agency to withhold the issuance or renewal of a license or permit to operate a business or engage in an activity in Minnesota until the applicant presents acceptable evidence of compliance with the workers' compensation insurance coverage requirement of Minnesota Statutes, Chapter 176. If the required information is not provided or is falsely stated, it may result in a $1,000 penalty assessed against the applicant by the commissioner of the Department of Labor and Industry. A valid workers’ compensation policy will be kept in effect at all times by employers as required by law.
BUSINESS NAME OF CONTRACTOR (Individual name only if no company name used) DBA (doing business as name) (if applicable) BUSINESS ADDRESS (PO Box must include street address) COUNTY CITY E-MAIL ADDRESS STATE ZIP CODE
YOUR LICENSE/BOND CERTIFICATE CANNOT BE ISSUED WITHOUT THE FOLLOWING INFORMATION. You must complete number 1 or 2 below.
LIC 04 (1/08)
Instructions for Completing the Certificate of Responsible Licensed Master Electrician/Elevator
Be sure to fill out this certificate completely. This form must be completed regardless of whether the master for the contractor is an owner, partner, member, officer, or employee of the company applying for a contractor's license. 1. Check if change of responsible person. 2. Responsible Licensed Person Name, Residential Address, daytime telephone number including area code, master license number and expiration date (you must have a current master license). 3. State the name of the legal business name and assumed name exactly as it appears on the Application for Electrical or Elevator Contractor’s License and on all the other forms. 4. The complete business address, business phone number, and contractor license number.
Note: Per Minnesota Statute 326.242, Subd. 6(c), all request for electrical inspection forms must be signed by the responsible master for the contractor unless the responsible master is an owner, partner, or officer of the corporation.
Instructions LIC ELE 12 (12/07)
Certificate of Responsible Licensed Individual Master Electrician/Elevator
Check if Change of Responsible Individual
PRINT IN INK or TYPE. Unreadable or illegible applications will be denied. Make a Copy for your records. Before a license card is issued to you the contractor, M.S. § 270C.72, subd 4, requires you to provide your social security number. The other information is required to process your application. Failure to provide the requested information may delay the processing of your application or may be grounds for denying your application. Under M.S. § 13.41, the information that you provide on this application, except for your name, and address is private data while the application is pending. Disclosure of this information to others may occur as authorized or required by law, including the Attorney General’s Office, the Department of Revenue, the Department of Human Services, and/or for the purpose of verification and investigation. Once you are registered, the information becomes public data (except your social security number) and will be part of the agency’s permanent records.
RESPONSIBLE LICENSED PERSON INFORMATION LAST NAME FIRST NAME
CONTRACTOR LICENSE INFORMATION LEGAL NAME BUSINESS NAME
LEGAL ASSUMED NAME (DBA) (if applicable)
CONTRATOR LICENSE NUMBER
This is to certify that pursuant to M.S. § 326B.33, subd. 6, I am the designated responsible person for the contractor set forth above, and as such, I will be responsible for: 1. planning, laying out, and supervising all electrical work as required by M.S. § 326B.33, subd. 1; 2. compliance with National Electrical Code safety standards as required by M.S. § 326B.35; 3. ensuring that, when required, each job will be done by, or under the individual on-the-job supervision of, properly licensed employees of said contractor as required by M.S. § 326B.33, subd. 5, and that one licensed individual will supervise no more unlicensed individuals on any job than allowed by M.S. § 326B.33, subd. 5; 4. ensuring that a Request for Electrical Inspection or other inspection form is filed at or before the commencement of all electrical installations requiring inspection as required by M.S. § 326B.36 and; 5. if I am not an owner or officer of the corporation holding said contractor's license, signing all Requests for Electrical Inspection as required by M.S. § 326B.33, subd. 6. 6. if I am not an owner or officer of the corporation holding said contractor’s license, I am the managing employee as required by M.S. § 326B.33, subd. 6c. Note: Minnesota Statutes Chapter 326B, sections 326B.081 to 326B.085 and Minnesota Statutes, sections 326B.31 to 326B.399 as found in Minnesota Session Laws, 2007, Chapter 140. I understand that unless I am licensed as the responsible licensed individual, and licensed as a contractor, doing business as an individual, as the responsible licensed individual for the contractor, I am prohibited by M.S. § 326., subd. 6c from being employed in any capacity as a licensed technician by any other contractor or employer. Unless I am licensed as the responsible licensed individual and licensed as a contractor, doing business as an individual, I will notify the Department 15 days in advance of resigning as the responsible licensed individual with said contractor, or immediately upon termination by said contractor. I also understand that under M.S. § 326B.082, subd. 12, the Department may revoke, suspend or refuse to renew any license granted pursuant to the Minnesota Electrical Act if a licensee knowingly and willfully makes a false statement in any license application or otherwise violates the requirements of the Minnesota Electrical Act and Minn. Rules chapter 3800.
SIGNATURE OF RESPONSIBLE LICENSED PERSON (mandatory) DATE
This material can be made available in different forms, such as large print, Braille or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or TDD (651) 297-4198. LIC ELE 12 (12/07)
Documents Similar To Department of Labor: eli electrical or elevator license