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Contractor Registration/Renewal Form

  1. Contractor Registration Form
    Registration Fee of $100
  2. Only required if different than the address above
  3. I hereby certify:*
  4. Insurance Certificate Required for the following:
    1. Comprehensive Liability, General Aggregate $2,000,000 min limits
    2. Proof of Worker's Compensation
    3. Proof of Automotive Liability
    4. City of Waukegan, as additional insured
  5. Demolition
  6. Electrical Waukegan Licensed
  7. Electrical Licensed in Illinois
  8. Elevator
  9. Excavator
  10. General Contractor
  11. HVAC
  12. Plumber
  13. Roofer
  14. Sign Erector
  15. Wireless Provider
  16. To upload multiple files, please hold the "CTRL" key when selecting files
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  20. Electronic Signature*
    By clicking on 'Electronically Sign' below, you understand that an electronic signature is taking place and you intend to be bound by and authenticate this electronic record and attest to the statements contained within, and that you understand that submitting another individual's electronic signature or attesting to false statements in an electronic record is a false statement that is punishable as unsworn falsification under AS 11.56.210; is an offering of a false instrument for recording that is punishable under AS 11.46.550; and may constitute other crimes such as perjury, theft, attempted theft, criminal mischief, forgery, criminal impersonation, scheme to defraud or criminal use of a computer; or other criminal offenses under state, municipal, or federal law.
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