875—150.4 (91C) Application. Each contractor shall file an application with the division for a registration number on forms provided by the division. The application shall contain the applicable information and documents specified in this rule.
	 150.4(1) Name. The name of the contractor.
	 150.4(2) Place of business. The complete mailing address of the principal place of business of the contractor.
	 150.4(3) Telephone number. The business telephone number of the contractor.
	 150.4(4) Business classification. The type of business entity of the contractor (i.e., corporation, partnership, sole proprietorship, trust, etc.).
	 150.4(5) Ownership information.
	  a.   	 If the contractor is a corporation, the name, address, telephone number, and position of each officer of the corporation.
	  b.   	 If the contractor is other than a corporation, the name, address, and telephone number of each owner.
	 150.4(6) Workers’ compensation coverage information.
	  a.   	 A certificate of insurance from the insurer showing proof of workers’ compensation insurance, the effective dates of coverage, and listing the division of labor as a certificate holder;
	  b.   	 Employer’s release from the insurance requirements under workers’ compensation law form provided to self-insured employers by the commissioner of insurance under Iowa Code section 87.11; or
	  c.   	 A statement that the contractor is not required to carry workers’ compensation coverage.
	 150.4(7) Account number. The employer account number or special contractor number issued by the unemployment insurance services division of the workforce development department prior to making application for a contractor’s registration number.
	 150.4(8) Business description. A description of the business to include:
	  a.   	 The employer’s North American Industry Classification System (NAICS) code; or
	  b.   	 The principal products and services provided.
	 150.4(9) Fee exemption. An exemption from fee may be requested if the contractor meets the requirements of and provides information specified in subrule 150.6(3).
	 150.4(10) Social security number. The contractor, if a natural person, shall include the contractor’s social security number.
	 150.4(11) Out-of-state contractor bond. An out-of-state contractor shall:
	  a.   	 File a surety bond in the amount of $25,000 for a one-year period that is prepared using the bond form provided by the division, or
	  b.   	 Provide a statement that the contractor is prequalified to bid on projects for the department of transportation pursuant to Iowa Code section 314.1.
[ARC 8812B, IAB 6/2/10, effective 7/1/10]