Title

Contractor License Application

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General info

Are you applying for a new license or a renewal of a current license?

Do you have a permit pending with Building and Inspections?

Business name

DBA name

Business phone

Business address

Address 2

Business city

Business state

Business ZIP/postal code

Applicant name

Applicant title

Applicant email

Applicant phone

Minnesota business tax ID number

The State of Minnesota requires that your MN Tax ID(not federal tax ID) be kept on file at the City of Bloomington. The MN Tax ID must be provided on your Contractor License Application prior to issuance of your contractor license. You may register to obtain your free MN Tax ID at the MN Department of Revenue's website.

Proof of workers' compensation insurance coverage

Insurance company name

Dates of insurance coverage

Policy number / self-insurance permit number (Per Minnesota State Statute 176.182)

I am not required to have workers' compensation liability coverage because:

I have no employees. (See Minn. Stat.§ 176.011, subd. 9 for the definition of an employee.)

I am self-insured for workers’ compensation (include a copy of authorization to self-insure from the Minnesota Department of Commerce).

I have employees but they are not covered by the workers’ compensation law. (See Minn. Stat. § 176.041 for a list of excluded employees.) Explain why your employees are not covered by attaching documentation.

Other:

Documentation

Explanation why employees are not covered by workers compensation law.

One file only.
100 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.

Mechanical contractor bond on file at the Minnesota Department of Labor and Industry (DOLI)

One file only.
100 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.

Valid Master Minneapolis or St. Paul Certificate of Competency or proof of passing the City of Bloomington's Mechanical Test.

One file only.
100 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.

Certificate of liability insurance with the City of Bloomington listed as Certificate Holder.

One file only.
100 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.

Fees

Fees may be paid by credit card by calling (952) 563-8728 or by mailing a check to City of Bloomington - Business Licensing, 1800 W. Old Shakopee Rd., Bloomington, MN 55431.

Mechanical - $75
Flammable tank - $75
Plumbing (incorporates gas) - NO FEE

Signature

Applicant signature

Use your mouse or finger to sign or or type your name in the field below.

Typed signature

Math question (2 + 6 =)

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Please take notice that any data received by the City as the result of submitting this form will be classified as government data pursuant to the Minnesota Government Data Practices Act, Minnesota Statutes Chapter 13. Under the Data Practices Act, some or all of this data is classified as public data, including your name, address, email address, phone number, and other personal information provided by you. Public data is available to anyone requesting it and consists of all data furnished via this Web form. Please be advised that the correspondence will be added to the public record. The purpose and intended use of the information collected through this form is to obtain public input and data in support of City activities and services. You have the right to refuse to submit this form. If you choose not to submit this form, you will need to contact the City by another means if you wish to provide the information collected by the form.

The City of Bloomington does not discriminate against or deny the benefits of its services, programs, or activities to a qualified person because of a disability. To make a request for a reasonable accommodation, ask for more information, or to file a complaint, contact the Community Outreach and Engagement Division, City of Bloomington, 1800 West Old Shakopee Road, Bloomington, MN 55431- 3027; 952-563-8733, MN Relay 711.

Contact Information

City Clerk's Office

952-563-8728

Email staff