NEW HANOVER TOWNSHIP
2943 N. CHARLOTTE STREET
GILBERTSVILLE, PA 19525
PH: 610-323-1008
FAX: 610-323-5173
CONTRACTOR’S REGISTRATION
Date: _________________
The undersigned hereby registers to work in New Hanover Township, Montgomery County, PA for the fiscal year beginning January 1.
Owner(s) Name _____________________________________________________
(Partners, Directors, Officers)
Business/Trade Name: _______________________________________________
Type of Trade: _____________________________________________________
(general contractor, concrete, electrician, mechanical, plumber, paver, etc.)
Business Address: ___________________________________________________
Business Phone: _________________________ Fax: _______________________
Applicant’s Signature: _______________________________________________
INSURANCE REQUIREMENT: No contractor’s license shall be issued unless the applicant files a certificate of insurance and worker’s compensation coverage with the Township at the time of the license application. The certificate of insurance and worker’s compensation coverage shall contain a provision that coverage afforded under the policy will not be cancelled until at least fifteen (15) days prior written notice of such cancellation has been given to the Township. The certificate of insurance must evidence policies of insurance for public liability, property damage, product liability and completed operations, each of which must have a single occurrence limit of a least $300,000.
For Township Use Only:
Approved: ___________________________ License Number: ___________________