Form DOC180 "Revision Application for General and Mechanical Contractors" - South Carolina

What Is Form DOC180?

This is a legal form that was released by the South Carolina Department of Labor, Licensing and Regulation - a government authority operating within South Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2021;
  • The latest edition provided by the South Carolina Department of Labor, Licensing and 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 DOC180 by clicking the link below or browse more documents and templates provided by the South Carolina Department of Labor, Licensing and Regulation.

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Download Form DOC180 "Revision Application for General and Mechanical Contractors" - South Carolina

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REVISION APPLICATION for GENERAL & MECHANICAL CONTRACTORS
Document #180
INSTRUCTIONS
1) INCREASE LICENSE GROUP LIMITATION:
Complete Sections A, B, and E.
1. Choose your desired Group Limitation on page 3.
2. You must submit either a FINANCIAL STATEMENT or a SURETY BOND for your selected Group Limitation.
Financial Document Option #1 - FINANCIAL STATEMENT:
Groups 1 and 2: submit the
Owner-prepared financial statement-Doc #172
o
Groups 3 and 4: submit a Compiled financial statement prepared by a licensed certified public accountant or a licensed
o
public accountant in accordance with GAAP, including all disclosures required by GAAP.
Group 5: submit an Audited balance sheet financial statement prepared by a licensed certified public accountant or a
o
licensed public accountant in accordance with GAAP, including all disclosures required by GAAP.
*
VERIFY AN ACCOUNTANT IS LICENSED AT:
HTTPS://CPAVERIFY.ORG
Income-tax basis financial statements are not accepted. Financial statements must be in your DBA “doing business as”
name. Financial statements require a balance sheet date no more than 12 months before the date of this application.
Personal financial statements of an entity's principals are accepted for a Sole Proprietorship, Partnership, Sole-Member
LLC, or a business with less than 2 years operating experience.
Financial Document Option #2 - SURETY BOND:
The surety bond must be from a surety provider authorized to transact surety business in this State in an amount of two
o
(2) times the required net worth for the Applicant’s selected licensing group for this renewal.
The surety bond must list the State of South Carolina as obligee for the bond.
o
The surety bond is for the benefit of any person who is damaged by an act or omission of the Applicant constituting a
o
breach of construction contract or a contract for the furnishing of labor, materials or professional services for construction
undertaken by the Applicant, or by any unlawful act or omission of the Applicant in performing construction.
The surety bond is in addition to, not in lieu of, any other surety bond required of the Applicant by law or regulation or by
o
any party to a contract with the Applicant.
The surety bond must provide that the surety must provide notice of cancellation to the Board and the Applicant thirty
o
(30) days prior to cancellation.
If the surety bond is cancelled, the licensee shall provide proof of net worth for the selected licensing
group with the required financial statement within ten (10) days of cancellation or the license is suspended until
written proof of required net worth is provided for the selected licensing group.
The terms of the surety bond cannot be amended and the Applicant must keep the bond in effect during licensure unless
the required financial statement is provided showing the required net worth for the selected licensing group.
Forms:
Surety Bond Form for General Contractors
- - -
Surety Bond Form for Mechanical Contractors
Doc 180 - Rev. 12/2021
Page 1 of 9
REVISION APPLICATION for GENERAL & MECHANICAL CONTRACTORS
Document #180
INSTRUCTIONS
1) INCREASE LICENSE GROUP LIMITATION:
Complete Sections A, B, and E.
1. Choose your desired Group Limitation on page 3.
2. You must submit either a FINANCIAL STATEMENT or a SURETY BOND for your selected Group Limitation.
Financial Document Option #1 - FINANCIAL STATEMENT:
Groups 1 and 2: submit the
Owner-prepared financial statement-Doc #172
o
Groups 3 and 4: submit a Compiled financial statement prepared by a licensed certified public accountant or a licensed
o
public accountant in accordance with GAAP, including all disclosures required by GAAP.
Group 5: submit an Audited balance sheet financial statement prepared by a licensed certified public accountant or a
o
licensed public accountant in accordance with GAAP, including all disclosures required by GAAP.
*
VERIFY AN ACCOUNTANT IS LICENSED AT:
HTTPS://CPAVERIFY.ORG
Income-tax basis financial statements are not accepted. Financial statements must be in your DBA “doing business as”
name. Financial statements require a balance sheet date no more than 12 months before the date of this application.
Personal financial statements of an entity's principals are accepted for a Sole Proprietorship, Partnership, Sole-Member
LLC, or a business with less than 2 years operating experience.
Financial Document Option #2 - SURETY BOND:
The surety bond must be from a surety provider authorized to transact surety business in this State in an amount of two
o
(2) times the required net worth for the Applicant’s selected licensing group for this renewal.
The surety bond must list the State of South Carolina as obligee for the bond.
o
The surety bond is for the benefit of any person who is damaged by an act or omission of the Applicant constituting a
o
breach of construction contract or a contract for the furnishing of labor, materials or professional services for construction
undertaken by the Applicant, or by any unlawful act or omission of the Applicant in performing construction.
The surety bond is in addition to, not in lieu of, any other surety bond required of the Applicant by law or regulation or by
o
any party to a contract with the Applicant.
The surety bond must provide that the surety must provide notice of cancellation to the Board and the Applicant thirty
o
(30) days prior to cancellation.
If the surety bond is cancelled, the licensee shall provide proof of net worth for the selected licensing
group with the required financial statement within ten (10) days of cancellation or the license is suspended until
written proof of required net worth is provided for the selected licensing group.
The terms of the surety bond cannot be amended and the Applicant must keep the bond in effect during licensure unless
the required financial statement is provided showing the required net worth for the selected licensing group.
Forms:
Surety Bond Form for General Contractors
- - -
Surety Bond Form for Mechanical Contractors
Doc 180 - Rev. 12/2021
Page 1 of 9
2) ADD A QUALIFYING PARTY (QP) or CLASSIFICATION:
Complete Sections A, D, E, the Affidavit of Eligibility page, and the Experience Affidavit page (as applicable)
*
All new QP's must submit a copy of their social security card and valid government issued ID (i.e. drivers license).
NOTE: For every separate license classification, there must be at least one individual to assume the role of a Primary Qualifying
Party for that classification. Additional individuals being added with classifications that already have a Primary Qualifying Party
can be listed as an Additional Qualifying Party.
• PSI and NASCLA Examined Applicants: New QP’s: submit a PSI technical exam PASS sheet or NASCLA transcript, and the
Business Management and Law exam PASS sheet. Current QP’s or QP's lapsed 4 years or less do not have to resubmit exams. Copy
Sections D and E if you are adding more than one QP with this application. For testing information, contact PSI at (855) 746-8173 or
online at https://candidate.psiexams.com. All new examined QP’s must complete the “Experience Affidavit” page.
• Waiver or MASC Applicants: You must have passed a technical exam in one of our participating states (see page 7). Otherwise, you
are required to take the PSI technical exam. You must not have any outstanding complaints with any professional licensing agency, and
you must be currently licensed and in good standing. Submit an “Examination Verification” from your state licensing board (copies of
licenses, certificates or out-of-state test results are not accepted). MASC applicants may submit a copy of their trade card. You must
have passed the SC Business Management & Law for Commercial Contractors exam - contact PSI at
https://candidate.psiexams.com
or (855)746-8173. You are exempt from completing the “Experience Affidavit” page.
• Non-Technical Exam Classification Applicants: You must have passed the SC Business Management & Law for Commercial
Contractors exam - contact PSI at (855) 746-8173 or https://candidate.psiexams.com. You must complete the “Experience Affidavit”
page. Non-technical classifications: Boring & Tunneling, Highway Incidental, Interior Renovation, Masonry, Railroad, Structural Shapes.
GENERAL CONTRACTOR CLASSIFICATIONS:
Asphalt Paving, Boiler Installation, Boring & Tunneling, Bridges, Building, Concrete, Concrete Paving, General Roofing, Grading, Glass & Glazing,
Highway, Highway Incidental, Interior Renovation, Marine, Masonry, Pipelines, Pre-Engineered Metal Buildings, Public Electrical Utility, Railroad,
Specialty Roofing, Structural Framing, Structural Shapes, Swimming Pools, Water & Sewer Lines, Water & Sewer Plants, Wood Frame Structures.
MECHANICAL CONTRACTOR CLASSIFICATIONS:
Air Conditioning, Electrical, Heating, Lightning Protection Systems, Packaged Equipment, Plumbing, Pressure & Process Piping, Refrigeration.
3) CHANGE BUSINESS NAME, ADDRESS, or CORPORATE OFFICERS:
Name & Address Changes: Complete Sections A, C and E. Officer changes: Complete Sections A, E, and F.
For name changes with the same Federal Tax ID No. and same style of business and for address changes: in Section A enter in your
previous information, and in Section C enter in your new information. For corporate name changes with the same Federal Tax ID No. and
style of business, please enclose a copy of your company’s amended corporate charter.
If your Federal Tax ID No. or style of business changed (i.e. from a Corporation to an LLC, etc.) within the past 15 business days, complete
this application and submit the Secretary of State Certificate of Amendment; or your company’s Articles of Amendment. If your change
was made more than 15 business days ago, do not complete this form. You must submit a new application,
Doc#
165, a financial
statement and license fee; you will be issued a new license number. You can download
Doc# 165
from www.llr.sc.gov/clb.
S.C. SECRETARY OF STATE Requirement: The S.C. Secretary of State requires all business corporations, nonprofit corporations,
limited liability companies, limited partnerships and limited liability partnerships to be registered with this state. Sole proprietorships and
general partnerships are not required to be registered. Register: 803-734-2158 or http://www.sos.sc.gov/Business_Filings.
SUBMIT YOUR APPLICATION PACKET AS FOLLOWS:
SC Contractor's Licensing Board
Fax:.............. (803) 896-4814
Regular Mail:............
PO Box 11329 Columbia SC 29211-1329
SC Contractor's Licensing Board
Email:...........
CONTACT.CLB@LLR.SC.GOV
Overnight Mail:.........
110 Centerview Drive
Columbia SC 29210
*** DO NOT SUBMIT PAGES 1-2 ***
*** MAKE COPIES OF ALL YOUR DOCUMENTS FOR YOUR RECORDS ***
Doc 180 - Rev. 12/2021
Page 2 of 9
CAMP / OFFICE USE ONLY
SS Card Enclosed?
OFFICE USE ONLY
Action taken:
Upgraded from
to
REVISION APPLICATION
 Name change  Address change
 New QP
for
General and Mechanical Contractors
QP#,
if applicable
 Added class(es)
Document #180
 Other:
Date Action Completed:
NO FEES REQUIRED FOR THIS APPLICATION
Submitting a Revision for the following:
(check all that apply)
Upgrade License Group Limit
Name Change
Address Change
Adding Qualifier
Adding Classification
Updating Personnel
Other:
SECTION A
- LICENSEE INFORMATION
(as it currently appears on your license card)
Licensee Name
SC License#:
:
Mailing Address:
Street or P.O. Box, City, State, Zip
SC County
Business Addre ss:
Same as above
Street, City, State, Zip (cannot be a P.O. Box address)
SC County
Business Phone (and Fax# if applicable) :
(
)
Federal Tax ID No:
Name of Owner/President:
Email(s) required:
- LICENSE INCREASE REQUIREMENTS
SECTION B
Select the group for increase. Attach EITHER the appropriate financial statement or surety bond.
GENERAL CONTRACTOR
(choose your selected Group Number based on these limits)
tatemen
-
General Contractor Minimum Net Worth Requirements (check applicable amount):
:
-
General Contractor Bond Amount Requirements (check applicable amount):
MECHANICAL CONTRACTOR
-
Minimum
-
0
Rev. 12/2021
Page 3 of 9
SECTION C - CHANGE OF BUSINESS NAME, ADDRESS or CORPORATE OFFICERS:
Attach amended corporate charter if this is a corporation name change. If the Federal ID No. or style of business has changed, do not complete this form; you
must submit a new application (Doc 165) and meet all initial application requirements.
Style of Business:
Sole Proprietorship
Partnership
Corporation
LLC
LLP
Federal Tax ID No:
New Business Name:
(DBA Name,
if different
from Legal Name)
Physical Address:
Street (cannot be a P.O. Box)
City
State
Zip
County (SC Addresses Only)
Mailing Address:
Same as above
P.O. Box or Street
City
State
Zip
County (SC Addresses Only)
)
(
Business Phone:
SECTION D - ADD QUALIFYING PARTY (QP) and/or ADD NEW CLASSIFICATION
Is the individual being added a current SC general or mechanical QP?
Yes*
No
*If Yes, select one of the two boxes below, if applicable. If No, disregard.
I am transferring my qualifications from the following previous license #:
I am requesting to be a dual qualifier for 2 different entities (you must submit
Doc #173
and meet all 4 requirements).
QUALIFYING PARTY “QP” -
The individual qualifying by Exam, Reciprocity, or Transferring from another licensed entity: Make a copy
of this section for each additional qualifier being added to the license.
Primary Qualifying Party (PQP)
Additional Qualifying Party (QP)
For the classification(s) I hold, I will be the:
All individuals completing this section must complete page 9 and submit a copy of their: (1) SS card, and (2) valid government
issued ID (i.e. drivers license). Applications will not be processed without this required documentation.
Legal Name:
SSN:
Individual Qualifying by Examination, Waiver, or a Non-technical Exam Classification
Mailing/Home Address:
Street, City, State, Zip
County-SC Residents
Business Address:
Contact Phone#: (
Position/Title with Licensee:
)
Date of Birth:
Driver’s License No.:
State Issued:
Classification(s)/Exams of PQP or QP:
I have obtained my classification(s) above by:
Exam
Non-Technical exam
Waiver (attach your state license verification form)
(attach PSI sheets)
I'm a current or inactive S.C. Qualifying Party
BACKGROUND QUESTIONS:
The Qualifying Party applicant must answer all questions below. For any “Yes” answers below, please
complete and submit
Document No. 142
“Explanatory Statement of Yes Answers” for each question a Yes answer applies. Official
documentation of judgment(s) or disposition(s) must also be provided.
1. Have you been convicted, pled guilty or nolo contendere in the U.S. or foreign country of the offense of forgery,
embezzlement, obtaining money under false pretenses, theft, extortion, or conspiracy to defraud or other like offense,
a felony or a crime involving moral turpitude? (If yes, a criminal background report must be submitted for any applicable
No
Yes
conviction as well as certified court disposition and any applicable supporting documentation)
2. Have you had a license or certificate denied, suspended, revoked, or otherwise been disciplined in South Carolina or
Yes
No
or any other state or jurisdiction (i.e. a citation, consent agreement, final order, or a Cease and Desist Order)?
Yes
No
3.
Had you had any outstanding monetary judgments related to construction?
4.
Do you have unresolved complaints or charges pending before any professional licensing board in South Carolina or
Yes
No
any other state or jurisdiction?.
Qualifying Party Signature
Title
Date
Doc 180 - Rev. 12/2021
Page 4 of 9
SECTION E
This section must be completed by the OWNER/PRESIDENT/AUTHORIZED REPRESENTATIVE.
Owner/President/Authorized Representative Printed Name: ____________________________________________________
For any “Yes” answers below, please complete and submit
Document No. 142
“Explanatory Statement of Yes Answers” for each person to whom
a Yes answer applies. Official documentation of judgment(s) or disposition(s) must also be provided by the applicable person and/or the entity’s
authorized agent.
1. Has the entity, owner/president, or any qualifying party been convicted, pled guilty or nolo contendere in the U.S. or foreign country
of the offense of forgery, embezzlement, obtaining money under false pretenses, theft, extortion, or conspiracy to defraud or
other like offense, a felony or a crime involving moral turpitude? (If yes, a criminal background report must be submitted for
Yes
No
any applicable conviction as well as certified court disposition and any applicable supporting documentation)
2. Has the entity, owner/president, or any qualifying party had a license or certificate denied, suspended, revoked, or otherwise
been disciplined in South Carolina or any other state or jurisdiction (i.e. a citation, consent agreement, final order, or a
Yes
No
Cease and Desist Order)?
Yes
No
3. Has the entity, owner/president, or any qualifying party had any outstanding monetary judgments related to construction?
4. Does the entity or owner/president have unresolved complaints or charges pending before any professional licensing
Yes
No
board in South Carolina or any other state or jurisdiction?
CERTIFYING STATEMENT:
The undersigned affirms responsibility that all information and statements contained herein are true in substance and effect.
Further, the undersigned understands that false or incorrect information provided may result in the cancellation or denial of a
license issued pursuant to this application and may be subject to civil and criminal proceedings. I agree that all information in this
application may be verified and investigated. I have read and am familiar with the South Carolina Contractor’s Licensing Board
Practice Act and hereby agree to abide by such laws.
Owner/President/Authorized Representative Signature
Title
Date
day of
, 20
Sworn and subscribed before me this
Notary Public Signature:
Notary for the State of:
My Commission Expires:
Print Notary's Name:
S
outh Carolina Law requires that every individual who applies for an occupational or professional license provide a social security number for use in the
establishment, enforcement and collection of child support obligations and for reporting to certain databanks established by law. Failure to provide your
social security number for these mandatory purposes will result in the denial of your licensure application. Social security numbers may also be disclosed
to other governmental regulatory agencies and for identification purposes to testing providers and organizations involved in professional regulation. Your
social security number will not be released for any other purpose not provided for by law.
Other personal information collected by the Department for the licensing boards it administers is limited to such personal information as is necessary to
fulfill a legitimate public purpose. The South Carolina Freedom of Information Act ensures that the public has a right to access appropriate records and
information possessed by a government agency. Therefore, some personal information on the application may be subject to public scrutiny or release.
The Department collects and disseminates personal information in compliance with The South Carolina Freedom of Information Act, the South Carolina
Family Privacy Protection Act, and other applicable privacy laws and regulations. Additionally, the Department shares certain information on the
application with other governmental agencies for various governmental purposes, including research and statistical services.
SECTION F - CHANGE/UPDATE OF AUTHORIZED REPRESENTATIVES:
Name
Title
DOB
Address
Telephone
Doc 180 - Rev. 12/2021
Page 5 of 9
Page of 9