City of Danville   

Contractor Information Form (must accompany this form)

Please provide the following contact information:

Name
Title
Company Name
Mailing Address
City
State
Zip/Postal Code
Business Phone
Cell Phone
Business FAX
Date Business Established
WebSite

Owner Name 

Unemployment # 

Owner Phone:

FEIN#

Liability Insurance Provider:

Workers Compensation Provider:

Surety Bond Provider:

Services Provided: (Select all that apply)

General Carpentry                                Awnings                    Siding             
Masonry                                              Asphalt Paving           Pool Installer     
Finish Carpentry                                   Fencing                     Drywalling
Signs                                                    Plumbing                   Mechanical                Electrical                                               Roofing    *State of Illinois Roofing License # Required

Principal Service

Your Name
Phone Number
Email Address
Today's Date

 I hereby certify that I understand that any person or company working for me as a subcontractor must be registered with the City of Danville and is not considered my employee. I hereby certify and attest that I have reviewed the information provided above and that such information is true and accurate, I understand that providing false information constitutes a violation of Chapter 165 of the City of Danville Code of Ordinances.

Warning! By checking this box, Under the laws of perjury, I verify that, to the best of my knowledge, the above information is true and correct . (Box must be checked to process application)

The Contractor Information Form must accompany this form. Click here to access the form