Form DBPR HR-7026 "Application for Elevator Company Registration" - Florida

What Is Form DBPR HR-7026?

This is a legal form that was released by the Florida Department of Business & Professional Regulation - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2018;
  • The latest edition provided by the Florida Department of Business & Professional Regulation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DBPR HR-7026 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

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Download Form DBPR HR-7026 "Application for Elevator Company Registration" - Florida

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DBPR HR-7026
APPLICATION FOR ELEVATOR COMPANY REGISTRATION
Application begins on page 2
Congratulations on your decision to register your elevator company! As you explore this opportunity, the Department of
Business and Professional Regulation’s (DBPR) Bureau of Elevator Safety is ready to assist you through the licensing
and regulatory process.
Our responsibility is to work with the business community to achieve the highest levels of health and safety for all
Floridians and more than 50 million annual visitors. Toward that goal, we are a resource you can use to see that your
new business operates within the requirements of the law.
This packet contains information regarding the legal requirements for your registration. It is very important that you
familiarize yourself with this information before you begin operating. If you have questions, or need any clarification,
please contact the DBPR Customer Contact Center at 850.487.1395 or go online to
www.MyFloridalicense.com/DBPR/elevator-safety/. Because our knowledge and authority are in state government
requirements, it is very important that you also contact local officials regarding any city and county requirements to
register as a new business.
We wish you the best of luck and success in your venture.
APPLICATION REQUIREMENTS:
Complete form DBPR HR-7026 Application for Registration for Elevator Company.
Submit proof of general liability insurance in a minimum amount of $100,000 per person and $300,000 per
occurrence valid for the entire registration term.
Submit the name and license number of at least one employee who is a valid certificate of competency holder
and/or certified elevator inspector.
Please send your completed application and documentation to:
Department of Business and Professional Regulation
Division of Hotels and Restaurants, Bureau of Elevator Safety
2601 Blair Stone Road
Tallahassee, FL 32399-1013
Please use the entire 9-digit zip code in the address above to ensure proper handling.
www.MyFloridalicense.com/DBPR/elevator-safety/
2018 January
Rule 61C-5.007, F.A.C.
Page 1 of 3
DBPR HR-7026
APPLICATION FOR ELEVATOR COMPANY REGISTRATION
Application begins on page 2
Congratulations on your decision to register your elevator company! As you explore this opportunity, the Department of
Business and Professional Regulation’s (DBPR) Bureau of Elevator Safety is ready to assist you through the licensing
and regulatory process.
Our responsibility is to work with the business community to achieve the highest levels of health and safety for all
Floridians and more than 50 million annual visitors. Toward that goal, we are a resource you can use to see that your
new business operates within the requirements of the law.
This packet contains information regarding the legal requirements for your registration. It is very important that you
familiarize yourself with this information before you begin operating. If you have questions, or need any clarification,
please contact the DBPR Customer Contact Center at 850.487.1395 or go online to
www.MyFloridalicense.com/DBPR/elevator-safety/. Because our knowledge and authority are in state government
requirements, it is very important that you also contact local officials regarding any city and county requirements to
register as a new business.
We wish you the best of luck and success in your venture.
APPLICATION REQUIREMENTS:
Complete form DBPR HR-7026 Application for Registration for Elevator Company.
Submit proof of general liability insurance in a minimum amount of $100,000 per person and $300,000 per
occurrence valid for the entire registration term.
Submit the name and license number of at least one employee who is a valid certificate of competency holder
and/or certified elevator inspector.
Please send your completed application and documentation to:
Department of Business and Professional Regulation
Division of Hotels and Restaurants, Bureau of Elevator Safety
2601 Blair Stone Road
Tallahassee, FL 32399-1013
Please use the entire 9-digit zip code in the address above to ensure proper handling.
www.MyFloridalicense.com/DBPR/elevator-safety/
2018 January
Rule 61C-5.007, F.A.C.
Page 1 of 3
DBPR HR-7026 – Application for Elevator Company Registration
STATE OF FLORIDA, DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
Division of Hotels and Restaurants, Bureau of Elevator Safety
2601 Blair Stone Road, Tallahassee, FL 32399-1013
Phone: 850.487.1395 – Email:
www.MyFloridaLicense.com/contactus/
Internet :
www.MyFloridalicense.com/DBPR/elevator-safety/
Please direct questions about this application to the Department of Business and Professional Regulation’s Customer Contact Center at
850.487.1395.
Section 1 – Type of Application (Client Code 2102)
This form is not to be used to renew an existing elevator company registration. Renewals may be completed
Initial (1030)
online or by submitting the license renewal notice mailed to the address on file with the division.
Section 2 – Company Information (MA)
Note: This address will be designated as the "address of record" for the party responsible for licensing and operation of this company.
FOR COMPANIES OWNED OR OPERATED BY CORPORATIONS OR PARTHNERSHIPS, please attach a separate sheet or sheets listing the name,
address, and social security number of each person who owns 10% or more of the outstanding stocks or equity interest in the licensed activity and the
name, address, and social security numbers of each officer, director, chief executive, or other person who, in accordance with the rules of the issuing
agency, is determined to be able directly or indirectly to control the operation of the business of the licensed entity. Under the Federal Privacy Act,
disclosure of Social Security Numbers is voluntary unless specifically required by Federal statute. In this instance, social security numbers are
mandatory pursuant to Title 42 United States Code, Sections 653 and 654; and sections 409.2577, 409.2598 and 559.79, Florida Statutes. Social
Security numbers are used to allow efficient screening of applicants and licensees by a Title IV-D child support agency to assure compliance with child
support obligations. Social Security numbers must also be recorded on all professional and occupational license applications and will be used for
licensee identification pursuant to the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Welfare Reform Act), 104 Pub.L.193,
Sec 317.
Company Name (Check one:
Corporation
Partnership
Individual)
Federal Employer Identification Number
Street Address or Post Office Box
City
Florida County
State
Zip Code (+4 optional)
Country
Primary E-Mail Address (Optional)
Primary Business Phone Number
Section 3 – License Location Information (LL)
Note: This address will be designated as the physical location address for this company.
Doing Business As Name
(if different than above)
Street Address
City
Florida County
State
Zip Code (+4 optional)
Country
E-Mail Address (Optional)
Primary Business Phone Number
Section 4 – License Mailing Information (LM)
Note: This address will be used by the department for all mailings to the company, including permits and license renewal notices
.
Routing Name (
)
e.g., Office Manager, contact name
Street Address or Post Office Box
City
Florida County
State
Zip Code (+4 optional)
Country
E-Mail Address (Optional)
Primary Business Phone Number
2018 January
Rule 61C-5.007, F.A.C.
Page 2 of 3
DBPR HR-7026 – Application for Elevator Company Registration
Section 5 – Certificate Of Competency / Certified Elevator Inspector (must have at least one)
Name
Florida License Number
Name
Florida License Number
Section 6 – Company Liability Insurance Coverage
Attach a copy of a current certificate of comprehensive general liability insurance demonstrating coverage for all
operations and offices covered in this registration. A current certificate must be maintained with the division.
Name of Insurance Company
Address
City
State
Zip Code (+4 optional)
Policy Number
Expiration Date
Section 7 – Signature
To qualify as a Registered Elevator Company, each company must:
1. Register with the bureau by submitting a current registration form.
2. Provide a copy of a certificate of comprehensive general liability insurance in a minimum amount of $100,000 per
person and $300,000 per occurrence valid.
3. Provide the name of at least one employee who holds a valid certificate of competency issued by the division or
is a certified elevator inspector licensed by the division.
SECTION 559.79 (2), Florida Statutes: Each application for a license or renewal of a license issued by the Department of
Business and Professional Regulation shall be signed under oath or affirmation by the applicant, or owner or chief
executive of the applicant without the need for witnesses unless otherwise required by law.
I certify that I am empowered to execute this application as required by Section 559.79, Florida Statutes. I understand
that my signature on this written declaration has the same legal effect as an oath or affirmation. Under penalties of
perjury, I declare that I have read the foregoing application and the facts stated in it are true. I understand that
falsification of any material information on this application may result in criminal penalty or administrative
action, including a fine, suspension or revocation of the license.
Printed name of applicant or authorized company representative
Title
Signature of applicant or authorized company representative
Date
Complete the application and mail it with the supporting documents to the address on this form. Please use the
entire 9-digit zip code in the address above to ensure proper handling.
2018 January
Rule 61C-5.007, F.A.C.
Page 3 of 3
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