Contractor Registration

2. 
4. NAME OF BUSINESS*
6. Address*
8. City*
9. State*
10. Zip Code*
12. LAND BASED PHONE
13. FAX
15. CELL PHONE
16. E-MAIL*
18. DESCRIPTION OF BUSINESS *
20. NAME OF OWNER *
21. NAME OF SUPERVISOR
23. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
25. Electronic Signature*
27. ( OFFICE USE ONLY )

    1. ALL CONTRACTORS - CERTIFICATE OF INSURANCE REQUIRED THAT NAMES THE VILLAGE OF NORTH RIVERSIDE AS ADDITIONALLY INSURED.
    2. PLUMBER AND ELECTRICIANS ONLY - $10,000 SURETY BOND REQUIRED.
    3. PLUMERS, ELECTRICIANS & ROOFERS - CODY OF CURRENT LICENSE
29. Certificate of Insurance*
30. $10,000 Surety Bond (Electricians)
32. Copy of Current License (Electricians, Plumbers and Roofers)
34. Fee and Payment Method

    The fee for contractor registration is $225.00 per calendar year.  We accept cash, check or credit card (Visa or MasterCard only) as a form of payment.  Credit card payments will incur a processing fee of 2.25%.  Checks should be made payable to the Village of North Riverside located at 2401 S. Desplaines Avenue, North Riverside, Illinois 60546.  

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38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

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