"Application for Construction Contractor Registration" - Montana

Application for Construction Contractor Registration is a legal document that was released by the Montana Department of Labor and Industry - a government authority operating within Montana.

Form Details:

  • Released on March 1, 2020;
  • The latest edition currently provided by the Montana Department of Labor and Industry;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Montana Department of Labor and Industry.

ADVERTISEMENT
ADVERTISEMENT

Download "Application for Construction Contractor Registration" - Montana

Download PDF

Fill PDF online

Rate (4.4 / 5) 7 votes
APPLICATION for Construction Contractor Registration
VALID FOR TWO (2) YEARS
CR#
OFFICE USE
$70 FEE (NON-REFUNDABLE)
Visit our website: mtcontractor.mt.gov or call (406) 444-7734 for assistance.
INSTRUCTIONS:
THIS BLOCK FOR OFFICE USE
☐ Complete this registration if your business is engaged in the construction industry and has employees, or is a Manager-Managed LLC, or a Corporation.
☐ LLCs and Corporations must register their business entity with the Montana Secretary of State’s office; business structure and principals will be verified.
☐ To qualify for “Bid Only” status, your out-of-state business cannot be actively performing work in Montana. Once awarded the job in Montana, you must notify
us in writing immediately to change your status and provide proof of a valid Montana workers’ compensation insurance policy for your employees.
☐ Businesses working in Montana with employees must provide proof of a valid Montana workers’ compensation insurance policy. Out of state businesses
– see reverse side or second page for requirements on demonstrating compliance with Montana’s workers’ compensation compliance.
☐ Enclose a check payable to the Montana Department of Labor & Industry (DLI) in the amount of $70 (non-refundable) or pay online.
☐ Sign and send this completed application to: Dept of Labor and Industry / Registration Section • PO Box 8011 • Helena, MT 59604-8011
Business Name:
Does this business use Employees?
☐Yes ☐No Policy#:
Name of workers’ compensation company:
Federal Employer Identification Number if required, or SSN:
Does this business use Leased Employees?
☐Yes ☐No Policy#
(Call the IRS at 1 (800) 829-1040 to verify your tax obligations)
Name of Professional Employer Organization (PEO):
Mailing Address:
Does this business use Temporary Employees? ☐Yes ☐No
Name of Temporary Service Contractor (TSC):
City:
State:
Zip:
☐Yes ☐No
Are you an out-of-state business and requesting “BID ONLY” status?
Phone:
Email:
Is this business in the construction industry?
☐Yes ☐No
Registered Agent:
Is this business in the trucking industry?
☐Yes ☐No
Does this business perform work solely on residential construction?
☐Yes ☐No
Business Structure: (Selection must match your business name registration with the Montana Secretary of State; contact their office at (406) 444-3665 for verification)
☐ Sole Proprietor
☐ Partnership or LLP
☐ Member-Managed LLC
☐ Manager-Managed LLC
☐ Corporation
(List Owner below)
(List Partners below)
(List Members below)
(List Managers below)
(List Corporate Officers below)
☐ Sole Proprietors, Partners, Members of Member-Managed LLC’s, and Managers of Manager-Managed LLC’s working on a jobsite in Montana, and are NOT personally covered under a Montana
workers’ compensation insurance policy, must have or apply for an active independent contractor exemption certificate (ICEC). Each ICEC application is $125 (non-refundable).
☐ Corporate officers working in Montana are considered employees and must be covered under a Montana workers’ compensation insurance policy, unless the officer owns 20% or more of the
shares of the corporation, or is related to another officer of the corporation and the aggregated shares equal 20% or more. See reverse side or second page for explanation.
If necessary, attach an additional sheet to list owners, partners, members, managers, or corporate officers.
*Corp Officers Only*
Personally
Work performed
Are you related to
covered by
Percent
in Montana:
another corporate
Montana
Owned:
(select all that
officer, and
First Name • MI • Last Name:
SSN:
Mailing Address • City • State • Zip:
workers’
apply)
combined shares
comp?
equal 20% or more:
☐Jobsite
☐Yes ☐No
☐Yes ☐No
%
☐Office ☐None
☐ ICEC
☐Jobsite
☐Yes ☐No
☐Yes ☐No
%
☐Office ☐None
☐ ICEC
☐Jobsite
☐Yes ☐No
☐Yes ☐No
%
☐Office ☐None
☐ ICEC
☐Jobsite
☐Yes ☐No
☐Yes ☐No
%
☐Office ☐None
☐ ICEC
Applicant Signature:
Printed Name:
Revised January 2020
APPLICATION for Construction Contractor Registration
VALID FOR TWO (2) YEARS
CR#
OFFICE USE
$70 FEE (NON-REFUNDABLE)
Visit our website: mtcontractor.mt.gov or call (406) 444-7734 for assistance.
INSTRUCTIONS:
THIS BLOCK FOR OFFICE USE
☐ Complete this registration if your business is engaged in the construction industry and has employees, or is a Manager-Managed LLC, or a Corporation.
☐ LLCs and Corporations must register their business entity with the Montana Secretary of State’s office; business structure and principals will be verified.
☐ To qualify for “Bid Only” status, your out-of-state business cannot be actively performing work in Montana. Once awarded the job in Montana, you must notify
us in writing immediately to change your status and provide proof of a valid Montana workers’ compensation insurance policy for your employees.
☐ Businesses working in Montana with employees must provide proof of a valid Montana workers’ compensation insurance policy. Out of state businesses
– see reverse side or second page for requirements on demonstrating compliance with Montana’s workers’ compensation compliance.
☐ Enclose a check payable to the Montana Department of Labor & Industry (DLI) in the amount of $70 (non-refundable) or pay online.
☐ Sign and send this completed application to: Dept of Labor and Industry / Registration Section • PO Box 8011 • Helena, MT 59604-8011
Business Name:
Does this business use Employees?
☐Yes ☐No Policy#:
Name of workers’ compensation company:
Federal Employer Identification Number if required, or SSN:
Does this business use Leased Employees?
☐Yes ☐No Policy#
(Call the IRS at 1 (800) 829-1040 to verify your tax obligations)
Name of Professional Employer Organization (PEO):
Mailing Address:
Does this business use Temporary Employees? ☐Yes ☐No
Name of Temporary Service Contractor (TSC):
City:
State:
Zip:
☐Yes ☐No
Are you an out-of-state business and requesting “BID ONLY” status?
Phone:
Email:
Is this business in the construction industry?
☐Yes ☐No
Registered Agent:
Is this business in the trucking industry?
☐Yes ☐No
Does this business perform work solely on residential construction?
☐Yes ☐No
Business Structure: (Selection must match your business name registration with the Montana Secretary of State; contact their office at (406) 444-3665 for verification)
☐ Sole Proprietor
☐ Partnership or LLP
☐ Member-Managed LLC
☐ Manager-Managed LLC
☐ Corporation
(List Owner below)
(List Partners below)
(List Members below)
(List Managers below)
(List Corporate Officers below)
☐ Sole Proprietors, Partners, Members of Member-Managed LLC’s, and Managers of Manager-Managed LLC’s working on a jobsite in Montana, and are NOT personally covered under a Montana
workers’ compensation insurance policy, must have or apply for an active independent contractor exemption certificate (ICEC). Each ICEC application is $125 (non-refundable).
☐ Corporate officers working in Montana are considered employees and must be covered under a Montana workers’ compensation insurance policy, unless the officer owns 20% or more of the
shares of the corporation, or is related to another officer of the corporation and the aggregated shares equal 20% or more. See reverse side or second page for explanation.
If necessary, attach an additional sheet to list owners, partners, members, managers, or corporate officers.
*Corp Officers Only*
Personally
Work performed
Are you related to
covered by
Percent
in Montana:
another corporate
Montana
Owned:
(select all that
officer, and
First Name • MI • Last Name:
SSN:
Mailing Address • City • State • Zip:
workers’
apply)
combined shares
comp?
equal 20% or more:
☐Jobsite
☐Yes ☐No
☐Yes ☐No
%
☐Office ☐None
☐ ICEC
☐Jobsite
☐Yes ☐No
☐Yes ☐No
%
☐Office ☐None
☐ ICEC
☐Jobsite
☐Yes ☐No
☐Yes ☐No
%
☐Office ☐None
☐ ICEC
☐Jobsite
☐Yes ☐No
☐Yes ☐No
%
☐Office ☐None
☐ ICEC
Applicant Signature:
Printed Name:
Revised January 2020
Revised: Mar 2020
ATTENTION CORPORATE OFFICERS:
Montana Code Annotated 39-71-401 (2) (r) exempts from workers’ compensation coverage, officers of a corporation and managers of a manager-managed limited liability company (excluding
managers of a manager-managed LLC working in the construction industry) who meet specified criteria. To be exempt, one of the following criteria must be met:
(i)
the officer or manager is not engaged in the ordinary duties of a worker for the corporation or the limited liability company and does not receive any pay from the
corporation or the limited liability company for performance of the duties;
(ii)
the officer or manager is engaged primarily in household employment for the corporation or the limited liability company;
(iii)
the officer or manager either:
owns 20% or more of the number of shares of stock in the corporation or owns 20% or more of the limited liability company;
(A)
owns less than 20% of the number of shares of stock in the corporation or limited liability company if the officer’s or manager’s shares when aggregated with the shares
(B)
owned by a person or persons listed in subsection (2) (r) (iv) total 20% or more of the number of shares in the corporation or limited liability company; or
(iv)
the officer or manager is the spouse, child, adopted child, stepchild, mother, father, son- in-law, daughter-in-law, nephew, niece, brother, or sister of a corporate officer who meets
the requirements of subsection (2) (r) (iii) (A) or (2) (r) (iii) (B).
If a corporate officer does not meet the criteria listed in Montana Code Annotated 39-71-401 (2) (r), they are required to be covered under a Montana workers’ compensation insurance policy.
DEMONSTRATING COMPLIANCE WITH MONTANA WORKERS’ COMPENSATION LAWS:
If your business has employees you will need to provide proof of a valid Montana Workers’ Compensation policy before the department will approve your CR. The department will attempt to verify
coverage using the National Council on Compensation Insurance (NCCI) national workers’ compensation database. However, there may be a delay in new policies being reported from insurers to
NCCI and there are some states that simply do not report to NCCI. To avoid possible delays in processing your CR, you must provide one of the two options listed below with your CR application.
Option 1: Providing a declarations page from the workers’ compensation policy provided all of the
Option 2: Providing a certificate of insurance (COI) issued by the contractor’s workers’
following conditions are met:
compensation insurer (or self-insured group) stating that the contractor’s employees are covered
for liability under the Montana Workers’ Compensation Act and Occupational Disease Act,
provided all of the following conditions are met:
The insurer is a company authorized to write workers compensation coverage in
Montana.
The insurer is a company authorized to write workers’ compensation coverage in
The name of insured as shown on the declaration page is the name of the business
Montana;
listed on the CR application.
The name of the insured as shown on the COI is the name of business listed on the CR
The federal employer identification number as shown on the declaration page is
application;
consistent with the FEIN listed on the CR application.
The insurer’s agent is licensed to do business in Montana;
Montana is listed specifically in section 3A. We will not accept a policy if Montana is
listed only in Section 3C and we do not accept an ‘all other states’ endorsement for
There is an original signature on the COI of an agent or other person that is authorized
businesses engaged in construction.
to bind the insurer;
A policy number appears on the declaration page.
The COI specifies that Montana is listed is section 3A of the policy; and
The declaration page is signed by an authorized agent of the insurer.
The COI must be validated within 20 days by the submission of a declaration page or
policy from the business.
Page of 2