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Contractor License Application

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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:

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 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 - $75.00; Flammable tank - $75.00; Plumbing (incorporates gas) - NO FEE

Applicant signature

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