Construction Trades Qualifying Board
APPLICATION FOR
PERSONAL and BUSINESS CERTIFICATION
SOLE PROPRIETORSHIP
APPLICATION FEES
MASTER/BUILDING SPECIALTIES PERSONAL CERTIFICATE...................................................................$315.00
EACH ADDITIONAL CATEGORY ........….…..…………………..……….……..……..................................................................................$315.00
BUSINESS INCLUDING D/B/A.........................................................................................................................$315.00
(Business Application not applicable to Journeyman and Maintenance man applicants)
MAKE CHECK PAYABLE TO MIAMI-DADE COUNTY
Refunds may be granted under specific circumstances and in those cases, there will be a non-refundable processing fee of $80. Refund
requests must be made in writing no later than 180 calendar days from the exam approved date. Original receipt must be presented for a
refund.
APPLICATION SUBMITTAL
Return this application and all supporting documents by mail or hand deliver to the Miami-Dade County Regulatory and Economic Resources
Department, Contractor Licensing Section, 11805 S.W. 26 Street, Room 207, Miami, FL 33175-2474. If you have questions, please contact one
of the following Contractor Licensing staff at (786) 315-2880.
*For Engineering categories, return application and all supporting documents to the Public Works Department at 111 NW 1
st
Street, Suite 1510,
Miami, FL 33128. For further information call (305) 375-2705.
FILING DATE
All Licensing applications must be reviewed and approved by the Construction Trades Qualifying Board. The completed application along with
the supporting documents and fee must be received by the Board meeting deadline. A notice will be sent to the applicant indicating the
results of Board and you may also contact us the following Monday after the meeting.
1
Karen Jackson
Maxine Canovas
Melinda Thomas
J
ulio Coronado
Juliet Prado
Jose Lezcano
Meeting Date:___________
Deadline:_______________
Licensing Representatives
Licensing Representatives
Licensing Representatives
Licensing Representatives
Licensing Representatives
Supervisor
Revised 7/6/2022
*EXAM CATEGORIES - JOURNEYMAN AND MAINTENANCE CATEGORIES TAKE ONLY ONE PART EXAM (TECHNICAL). ALL OTHER CATEGORIES
TAKE TWO PART EXAM (TECHNICAL AND
BUSINESS). **CATEGORIES REQUIRING STATE
REGISTRATION
CONSTRUCTION TRADES QUALIFYING BOARD
LIST OF CERTIFICATION CATEGORIES
BUILDING
General Contractor**
BLDG
0001
4 years’ experience - one as a supervisor/forman
Building Contractor**
BLDG
0002
4 years’ experience - one as a supervisor/forman
Residential Contractor**
BLDG
0003
4 years’ experience - one as a supervisor/forman
BUILDING SPECIALTIES
Caulking
BLDG
2 years’ experience
Canvas Awning
BLDG
1 year experience
Communication Tower*
BLDG
3 years’ experience
Concrete Finishing
BLDG
2 years’ experience
Concrete Forming and Placing*
BLDG
3 years’ experience
Concrete Slab Sawing & Core Drilling*
BLDG
1 year experience
Demolition*
BLDG
3 years’ experience
Door
BLDG
1 year experience
Drywall*
BLDG
1 year and 6 months
Fence*
BLDG
1 year experience
Finish Carpentry
BLDG
2 years’ experience
Flagpole
BLDG
1 year experience
Flooring
BLDG
1 year experience
Garage and Industrial Door
BLDG
1 year experience
Glass and Glazing*
BLDG
3 years’ experience
Gypsum Drywall Installer
BLDG
2 years’ experience
Gypsum Drywall Finisher
BLDG
2 years’ experience
Insulation and Acoustical Tile
BLDG
2 years’ experience
Limited Residential Repair
BLDG
3 years experience
Lathing and Plastering*
BLDG
3 years’ experience
Decorative Concrete & Masonry Fence
Metal Awning & Storm Shutter*
BLDG
BLDG
FENCES)1 year experience
1 year experience
Metal Decking & Siding*
BLDG
3 years’ experience
Metal Partition
BLDG
1 year experience
Miscellaneous Metals*
BLDG
3 years’ experience
Ornamental Iron
BLDG 0035(CANNOT INSTALL FENCES) 2 years' experience
Painting
BLDG
1 year experience
Pneumatic Concrete &
Pressure Grouting*
BLDG
3 years’ experience
Pre-stressed Pre-cast
Concrete Erection*
BLDG
3 years’ experience
Revised 7/6/2022
*EXAM CATEGORIES - JOURNEYMAN AND MAINTENANCE CATEGORIES TAKE ONLY ONE PART EXAM (TECHNICAL). ALL OTHER CATEGORIES
TAKE TWO PART EXAM (TECHNICAL AND
BUSINESS). **CATEGORIES REQUIRING STATE
REGISTRATION
Public Seating
BLDG
0041
3 years experience
Reinforcing Steel Placing*
BLDG
0042
3 years’ experience
Roof**
BLDG
0044
3 years’ experience
Roof Deck*
BLDG
0046
1 year experience
Screen Enclosure*
BLDG
0048
1 year experience
Sheet Metal Gutter & Downspout
BLDG
0049
1 year experience
Shower and Tub Enclosure
BLDG
0050
1 year experience
Sign – Non Electric*
BLDG
0051
3 years’ experience
Structural Steel Erection*
BLDG
0054
5 years’ experience
Swimming Pool**
BLDG
0055
3 years’ experience
Tennis Courts Surfacing
BLDG
0056
1 year experience
Traditional Thatched Hut
BLDG
0117
2 years’ experience
Unit Masonry, Marble, Ext Veneer*
BLDG
0059
3 years’ experience
Waterproofing
BLDG
0109
3 years’ experience
MAINTENANCE
Building Maintenance*
BLDG
0007
1 year experience
Maintenance Electrician*
ELEC
0005
1 year experience
Mechanical Maintenance*
MECH
0012
1 year experience
Plumbing Maintenance*
PLUM
0004
1 year experience
ELECTRICAL
Journeyman Electrician*
Journeyman Burglar Alarm*
Journeyman Fire Alarm*
Journeyman Sign Electrician*
Master Electrician**
ELEC
ELEC
ELEC
ELEC
ELEC
0001
3 years’ experience
3 years’ experience
3 years’ experience
3 years’ experience
2 years as journeyman
Master Burglar Alarm**
ELEC
0002
2 years as journeyman
Master Electrical Utility**
ELEC
0008
2 years’ experience
Master Fire Alarm**
ELEC
0004
2 years as journeyman
Master Low Voltage**
ELEC
0037
2 years’ experience
Master Sign Electrician**
ELEC
0003
2 years as journeyman
Master TV Antenna*
ELEC
0006
2 years’ experience
PLUMBING
Journeyman Plumber*
PLUM
0001
3 years’ experience
Master Plumber**
PLUM
0001
2 years as journeyman
Lawn Sprinkler*
PLUM
0003
2 years’ experience
Revised 7/6/2022
*EXAM CATEGORIES - JOURNEYMAN AND MAINTENANCE CATEGORIES TAKE ONLY ONE PART EXAM (TECHNICAL). ALL OTHER CATEGORIES
TAKE TWO PART EXAM (TECHNICAL AND
BUSINESS). **CATEGORIES REQUIRING STATE
REGISTRATION
Master Pool Maintenance (unlimited)* PLUM 0009
Master Swimming Pool Piping*
PLUM
0010
Master Portable Chemical Toilets
PLUM
0005
2 years’ experience
2 years’ experience
2 years’ experience
2 years’ experience
MECHANICAL
Journeyman Air Conditioning*
MECH
0004
3 years’ experience
Journeyman Gasoline Tank & Pump*
MECH
0009
3 years’ experience
Journeyman General Mechanical*
MECH
0001
3 years’ experience
Journeyman Heating*
MECH
0010
3 years’ experience
Journeyman Insulation*
MECH
0011
3 years’ experience
Journeyman Pneumatic Control Piping*
MECH
0014
3 years’ experience
Journeyman Pressure & Process Piping*
MECH
0016
3 years’ experience
Journeyman Refrigeration*
MECH
0020
3 years’ experience
Journeyman Room Air Conditioning*
MECH
0021
3 years’ experience
Journeyman Sheet Metal*
Journeyman Steam Generator
Journeyman Boilers & Piping*
MECH
MECH
0023
0024
3 years’ experience
3 years’ experience
Journeyman Warm Air Heating*
MECH
0027
3 years’ experience
Master Air Conditioning Limited**
MECH
0002
2 years as journeyman
Master Air Conditioning Unlimited**
MECH
0003
2 years as journeyman
Master Ammonia Refrigeration*
MECH
0005
2 years as journeyman
Master Gasoline Tank and Pump*
MECH
0009
2 years as journeyman
Master General Mechanical**
MECH
0001
2 years as journeyman
Master Heating*
MECH
0010
2 years as journeyman
Master Insulation*
MECH
0011
2 years as journeyman
Master Pneumatic Control Piping*
MECH
0014
2 years as journeyman
Master Pneumatic Tube Conveyor*
MECH
0015
2 years’ experience
Master Pressure & Process Piping*
MECH
0016
2 years as journeyman
Master Refrigeration & Air Condition**
MECH
0017
2 years as journeyman
Master Refrigeration Limited*
MECH
0018
2 years as journeyman
Master Refrigeration Unlimited*
MECH
0019
2 years as journeyman
Master Room Air Conditioning*
MECH
0021
2 years as journeyman
Master Sheet Metal*
Master Steam Generator
Master Boiler and Piping*
MECH
MECH
0023
0024
2 years as journeyman
2 years as journeyman
Master Transporting Assembly Install*
Master Transporting Assembly
Maintenance & Service*
MECH
MECH
0025
0026
2 years as journeyman
2 years’ experience
Master Warm Air Heating*
MECH
0027
2 years as journeyman
Master Pool Maintenance (limited)* PLUM 0008
Revised 7/6/2022
Construction Trades Qualifying Board
PHOTOGRAPH
One recent photo must be
attached
DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES
11805 S.W. 26th Street, Room 207
Miami, FL 33175-
2474
SECTION A: to be filled out by the individual that is filing for a
PERSONAL CERTIFICATION
PLEASE TYPE OR PRINT (must be legible). An answer must be provided for each question. If a
question does not apply indicate “N/A”.
Trade and category applying for ___________________________________________________
1. Name ____________________________________________ Last 4 of SS# _________________________
Phone: Home ______________________ Work ______________________ Pager or Cellular ______________________
Fax: _________________________________________ Email Address: _______________________________________________
Address _________________________________________________ City _________________ State ____ Zip Code _____________
Driver’s License No. __________________________ Place of Birth _______________________ Date of Birth __________ Age _____
Include copy of Driver’s License
2. Number of years working in trade applied for: ____________ Yrs. as a Trainee: ___________ Yrs. as Journeyman: ____________
3. If applying for a MASTER examination and the prerequisite is a Miami-Dade County Journeyman certification, when did you pass the
Journeyman examination? __________________________
4. Have you previously taken an examination in Miami-Dade County in the category you are now applying for? Yes _____ No _____
If Yes, when? ____________________________________________________________
5. Were you previously denied in Miami-Dade County to take an examination? If yes, in which category and for which exam date?
Category ______________________________ Exam date ______________________________
6. As a condition of this application, you will be responsible for becoming familiar with and abiding by the requirements of Chapter 10 of
the Code of Miami-Dade County. Have you read Chapter 10 of the Code of Miami-Dade County? Yes _____ No _____
7. Do you hold a certificate/license in any of the construction trades issued by any county or state board? Yes _____ No _____
If yes, attach copy.
IMPORTANT NOTE!
Before the Construction Trades Qualifying Board can review your application all trade experience must be documented by letters, W-2 forms,
and/or other documentary proof of such experience from all subject employers. It is the applicant’s responsibility to contact employers and
obtain from them such documentary proof. In place of the letter, an 'Affivavit of Experience' form included with this application can be completed
by the employer and provided upon filing the application.
TRADE EXPERIENCE
8. List below your complete trade experience related to the category for which you are applying. Be accurate and detailed since this
information will be verified. If additional space is needed please use back of this page.
(BEGIN WITH CURRENT EMPLOYER)
DATE
FROM: Month/Yr. TO: Month/Yr.
Company Street City State Zip
In what capacity did you work, or what did you do?
Company Street City State Zip
In what capacity did you work, or what did you do?
Company Street City State Zip
1
License Number
License Number
License Number
Revised 7/6/2022
3
In what capacity did you work, or what did you do?
Company Street City State Zip
In what capacity did you work, or what did you do?
Company Street City State Zip
In what capacity did you work, or what did you do?
EDUCATION
9. Please provide the following information about your educational background.
HIGH SCHOOL __________________________________________________________ City _______________ State _____ Year ________
If applicable General Education Degree (GED) __________________________________ City _______________ State _____ Year ________
VOCATIONAL/TRADE SCHOOL __________________________
___________________ City _______________ State _____ Year ________
COLLEGE _______________________________________________________________ City _______________ State _____ Year ________
DEGREE TITLE ___________________________ Year Obtained _______
POST
GRADUATE ________________________________________________________ City _______________ State _____ Year ________
OTHER SCHOOLING (Military Service or other) ___________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
LIST RELEVANT SCHOOL COURSES TAKEN ___________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
LICENSURES ______________________________________________________________________________________________________
__________________________________________________________________________________________________________________
License Number
License Number
Revised 7/6/2022
4
RESUME OF APPLICANT’S EXPERIENCE
In order for the CTQB to properly assess your experience in terms of authorized scope of work categories listed in Chapter 10 of the Code of
Miami-Dade County, it is required that you complete this resume.
11. PLEASE EXPLAIN IN DETAIL THE WORK YOU HAVE PERFORMED IN THE FIELD IN CONJUNCTION WITH THE CATEGORY IN
WHICH YOU ARE REQUESTING TO BE CERTIFIED. IN ADDITION, HIGHLIGHT THOSE JOBS THAT BEST DEMONSTRATE THE
SKILLS REQUIRED FOR THE APPLICABLE TRADE.
(ATTACH ADDITIONAL SHEET IF NECESSARY)
I certify that the above described work and experience recorded represents to the best of my knowledge all information relative to the scope of
work and category for which I am applying. I further certify that all supporting documentation submitted with this application is true and
accurate. I understand that an issuance of a personal certificate does not permit me to act as a contractor in the trade concerned and in order
to work in the trade I must be employed by a licensed contractor. I realize that if I do contract without a contractor’s business certificate of
competency, I will face the possibility of receiving a fine of up to $5,000 on each count and my personal certificate could be suspended or
revoked by the Miami-Dade County Construction Trades Qualifying Board. I understand that refunds may be granted underspecific
circumstances but will not include a non-refundable process fee of $80.
X_______________________________________
Applicant’s Signature
STATE OF _______________________________
COUNTY OF _____________________________
The foregoing instrument was acknowledged before me this _______________ day of ___________________ ,
20 ____ , by _________________________________________________________ , who is personally known to me or who has
produced a ______________________________________________ as identification and who did / did not take an oath.
_______________________________________
NOTARY PUBLIC
Revised 7/6/2022
Construction Trades Qualifying Board AFFIDAVIT
OF TRADE EXPERIENCE
MUST BE COMPLETED BY THE QUALIFIER VERIFYING EXPERIENCE
and who is currently
qualifying the company below
This is to certify that
employed by ____________________________________________________________________________
located at ________________________________________________________________________________
Telephone #: ____________________________
from
to
His/her total length of time in the field was
_________________________
____________________________________________________________________
_____________________________________________________________________________________________
The specific type of work performed consisted of the following:
is/was
Issued by
Signature:
Print:
Contractor.
License #
as a
STATE OF FLORIDA)
SS:
COUNTY OF DADE)
I hereby certify that on this ____ day of ____________
_______. A.D. 20______ be
fore me did personally
appear ____________________ to me known to be the person described in and who executed the forgoing
instrument and did acknowledge that he/she executed the same freely and voluntary and for the uses and
purposes therein mentioned and that all statements contained therein are true and honest to the best of his/her
knowledge.
WITNESS my signature at Miami, in the County and State aforesaid on the day and
year last aforesaid.
NOTA
RY
PUBLIC:____
__
____
____
___
_
My commi
ssi
on expire
s
Revised 7/6/2022
Construction Trades Qualifying Board
APPLICATION INSTRUCTIONS FOR MIAMI-DADE COUNTY
CONTRACTOR'S BUSINESS CERTIFICATE OF COMPETENCY
CODE REGULATIONS Chapter 10 of the Code Of Miami-Dade County requires any persons, sole proprietorships,
partnerships or other business entities desiring to engage in the business or acting in the capacity of a contractor or subcontractor
in the construction field in both the incorporated and unincorporated areas of Miami-Dade County to be approved and certified by
the Miami-Dade County Construction Trades Qualifying Board (CTQB), State of Florida Construction Industry Licensing Board or
the State of Florida Electrical Contractors Licensing Board. The CTQB will, as authorized by law, consider the work experience of
the qualifying agent, financial status and other pertinent information relative to the applicant in determining if the application should
be approved.
APPLICATION GUIDELINES
1. The following are guidelines on the applications required to be completed in order to obtain a Business Certificate of
Competency: Applications may be typed or handwritten with blue/black ink (must be legible).
If a Corporation or a Business Entity other than a sole proprietorship or partnership, a Business Application for
Corporation/Business Entity form must be completed. (Section A of the application must be completed by the Qualifying
Agent. Section B of the application must be completed by the Qualifying Agent, president or authorized officer.)
If a Sole Proprietorship, a Business Application for a Proprietorship form must be completed. (The qualifying agent
must complete the entire business application.)
If a Partnership, a Business Application for a Partnership form must be completed. (Section A of the personal
application must be completed by the Qualifying Agent.) (Section B of the Business Application must be completed by the
Qualifying Agent of the Partnership and the Partners of the Company.)
For a Change of Affiliation, a Business Application, Outgoing Affidavit (Change of Affiliation) form must be
completed.
To place a certificate in inactive status, an Outgoing Affidavit (Inactive Status) form must be completed.
To add a "DBA" to an EXISTING business license, a Business Application,form must be completed along with a
fee of$315.00.
2. An answer must be provided for each question. If a question does not apply, please indicate "N/A" (Not Applicable).
3. Applications must be sworn to before a Notary Public and bear a Notary Seal. Applicants are responsible for having the
business application notarized prior to submission to the Contractor Licensing Section.
4. The Qualifying Agent must have a significant interest or financial interest in the entity he/she is qualifying as evidenced by
his/her position as an officer or partner or principal stockholder in accordance with Section 10-6 (E) 5 of the Code of Miami-Dade
County.
5. If you are qualifying a Corporation, you must obtain from the Secretary of State, Tallahassee, Florida, the CERTIFICATE OF
STATUS UNDER THE GREAT SEAL showing the corporation is currently authorized to do business in Florida. A copy must be
submitted with the application.
6. The applicant must submit a copy of the Articles of Incorporation with proof of acknowledgment by the Florida Department of
State or By-laws, whichever applicable. To obtain or make a change to the Articles of Incorporation call the Florida Department of
State, Division of Corporations at (850) 245-6051/(850) 245-6052 or visit their website www.sunbiz.org.
7. Under the Fictitious Name Law, if your business entity (does not apply to corporations) bears something other than your full
legal name, it is necessary that you secure a certificate from the Secretary of State, Tallahassee, Florida, at (850) 245-6058
indicating that you have registered. This certificate must be submitted with the application.
8. If you are qualifying a business entity other than a corporation or Sole-Proprietor, you must submit documents that
demonstrate the ownership interest of the business including, but not limited to, name, home address, and ownership interest.
Revised 7/6/2022
9. CERTIFICATE OF GENERAL LIABILITY INSURANCE. A certificate of general liability insurance must be provided with the
following minimum insurance requirements before a Contractor's Certificate of Competency can be issued.
Minimum Insurance Limits:
Bodily Injury Liability $300,000 Per accident or occurrence
Property Damage $ 50,000 Per accident or occurrence
The Certificate of General Liability Insurance must be in the name of the Sole Proprietorship, Partnership, Joint Venture,
Corporation or other business entity. The Certificate of General Liability Insurance should not be obtained until after the
application has been approved by the CTQB.
NOTE: Insurance certificate must be made out to: Miami-Dade County Department of Regulatory and Economic Resources.
11805 S.W. 26 Street, Room 207, Miami, FL 33175.
10. CERTIFICATE OF WORKER’S COMPENSATION INSURANCE Worker's compensation insurance must be presented to the
municipal building department when pulling permits. In the case of the Unincorporated Dade County Regulatory and Economic
Resources Department, worker's compensation insurance must first be presented to the Contractor Licensing Section in order to
pull permits and/or engage in business. If a contractor applicant is exempt from the Worker's Compensation Insurance, he/she
must submit to the Contractor Licensing Section an executed exemption issued by the Florida Division of Worker's Compensation
(305) 536-0306 / (850) 419-1609) http://www.myfloridacfo.com/division/WC/ . Excemption certificate must be issued to the
qualifying agent and qualifying company.
.
11. All qualifying agents qualifying a Miami-Dade County Department are exempt from providing a Certificate of General Liability
and Worker's Compensation Insurance.
12. Pursuant to Administrative Order No. 4-112, the following fee must accompany the application:
$315 per Business Certificate of Competency or add D/B/A.
If you are an active certified contractor and want to add additional qualifying agent(s), you must
submit a personal and business application and pay the required fee of $630.00 for each additional qualifying
agent.
$350 per Change of Affiliation
A Change of Affiliation occurs when an active certified contractor changes the name of their business or wishes to
leave the company he/she is qualifying in order to qualify another business entity. Please note, that a personal certificate
of eligibility is required before you can qualify a business.
$150 per Inactivation of Business Certificate of Competency
Note: Please make your check payable to Miami-Dade County
13. FILING DATE: Before CTQB can consider the issuance of a business certificate of competency; a personal & business credit
reports must be ordered by the applicant and received prior to the meeting. Also, the completed application, along with all
supporting documents as required with the fee, must be received at least thirty (30) calendar days before the next scheduled
CTQB meeting. A notice of the board decision will be sent to the applicant approximately ten (10) business days after the CTQB
meeting.
14. IMPORTANT! If you fail to finalize your paperwork within 180 days from the date of CTQB approval, your application will be
NULL AND VOID and you will be required to pay the full application fee to re-file.
15. APPLICATION SUBMITTAL Return this application and all supporting documents by mail to the Miami-Dade County
Regulatory and Economic Resources Department, Contractor Licensing, 11805 S.W. 26 Street, Room 207, Miami, Florida 33175-
2474. You may also hand deliver documents to Contractor Licensing located on the 2nd floor of the same building. If you have
questions, please contact the Contractor Licensing staff at (786) 315-2880.
Licensing Representative
Lourdes Maytin, Melinda Thomas, Ronnie Diaz, Karen Jackson
Jose Lezcano, Supervisor
NO APPLICATION OR PART THEREOF WILL BE ACCEPTED UNLESS COMPLETELY FILLED OUT, PROPERLY
EXECUTED AND ACCOMPANIED BY ALL REQUIRED SUPPORTING DOCUMENTS AND THE REQUIRED FEE.
Revised 7/6/2022
SECTION B:
BUSINESS APPLICATION
for a
SOLE PROPRIETORSHIP
QUALIFIER INFORMATION (To be completed by the Qualifying Agent)
Trade and Category (Refer to category list)
1 .
Height
Weight
Color of Hair
Date of Birth
Place of Birth (City and State)
Business Name
Position
□
YES
□
What type of license?
When?
Where?
□
YES
□
□
YES
□
If YES, provide Certificate No.
□
YES
□
If YES, in what county?
In what trade?
Provide name of business entity
If applicable, provide state registration No.
b. Are you qualifying a business entity in this or some other county within the State of Florida?
NO
qualify (or indicate ''Inactive'', if appropriate).
4.
a
Do you currently hold a certificate issued by any Florida State Board? NO
and the name of the business entity you
Why were you refused?
Written Exam? NO
Were you ever refused a contractor's license? NO
3.
Have any of the Officers or Directors of the corporation/business entity been arrested or convicted of a felony in the state
of Florida or elsewhere? .
NO___ YES___ If YES, state where and the nature of offense. Provide name of court and case number
.
2.
NAICS CODE (See Attached List)
Business Fax No.
Business Telephone No.
Zip Code
State
City
Business Address
Driver's License No.
Home Telephone No.
Zip Code
State
City
Home Address
Last 4 digits of SS#
Name of Qualifying Agent
Revised 7/6/2022
.
Have you the Qualifying Agent ever had a certificate of competency (business certificate) suspended or revoked
5.
by the State of Florida Construction Industry Licensing Board or other state licensing authority or the licensing
authority of another municipality or county whether located in the State of Florida or another State?
NO
YES
If YES, please explain.
□
YES
□
If YES, please explain.
1 .
2.
3.
4.
□
YES
□
If YES, please explain,
□
YES
□
If YES, please explain.
Have you as an individual, or as an officer or director of a corporation, or member of a business entity ever
benefited from or caused injury to another as the result of an act within the past three years involving dishonesty
negligence, fraud, deceit or lack of integrity?
NO
Have you as an individual, or as an officer or director of a corporation or member of a business entity committed
an act within the past three years which if committed or done by a licensed contractor would be grounds for
suspension or revocation of such contractor's license? NO
PHONE
ADDRESS
NAME
REFERENCES. List four references which can provide information as to your competency and financial
responsibility. An employer, an architect or engineer, a supply house and a financial institution are suggested.
Have you ever failed in business? NO
List all businesses owned, operated or managed by you at the present time, and all businesses in which you have
had an active part in Florida or elsewhere during the last five years with addresses.
6.
7.
8.
9.
10.
Revised 7/6/2022
The following are definitions needed in order to answer the next set of questions.
(i) If a sole proprietorship, the qualifying agent; or owner
(ii) For purpose of this rule, ''responsible person" includes a qualifying agent, any partner, joint venture partner, corporate officer,
corporate director, trustee and stockholder controlling 25% or more in a corporation.
11,
Has any bonding or surety company ever completed or made a financial settlement upon any construction contract work
undertaken by any person named in (i) above or any organization in which such person was a responsible person as
defined in (ii) above? NO YES
12.
Are there now any liens, suits or judgments of record or pending against any person named in (i) above or any
organization in which any such person was a responsible person as defined in (ii) above, as a result of the construction
operations of such person or organization? NO YES
13.
Are there now any liens of record by the U.S. Internal Revenue Service or the State of Florida Corporate Tax Division
against any person named in (i) above or any organization in which any such person was a responsible person as defined
in (ii) above? NO YES
Has any person named in (i) above or has any organization in which any such person was a responsible person as
defined in (ii) above ever made an assignment of assets in settlement of construction obligations for less than the total
amount of the indebtedness? NO YES
14.
Has any person named in (i) above or has any business entity in which any person was a member been convicted of
acting in the capacity of a contractor without a license or if licensed as a contractor in this or any other state, has any
disciplinary action (inclu
ding probation, fine or reprimand) ever been taken against such license by a state, county
or
municipality? NO YES
15.
Has any person in (i) above or has any business entity in which such person was a responsible person as defined
in (ii) above ever been convicted of a felony in this state or elsewhere?
NO____ YES____
16.
X
I certify that I will act for the sole proprietorship I am qualifying, in all matters concerning the contracting business, and will actively
supervise all construction work and be responsible for ascertaining that all such work is completed according to approved plans,
applicable codes and good construction standards. I will immediately notify the Construction Trades Qualifying Board (CTQB) if I
sever connections with the business entity. I am aware that I must finalize my paperwork within 180 day
s from the date of CTQB
approval and if I fail to do so my application will be n
ull and void and I will be required to pay the full fee to refile. I am also aware
that the fee for this application is non-refundable.
1, the Sole Proprietor, do hereby certify that
I further certify that I will notify the Board immediately if
X
Sworn to and Subscribed before me that this is a true statement this
My Commission Expires
20
day o
f
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
Print Name of Sole Proprietor
Signature of Sole Proprietor
sever connections with the Sole Proprietorship.
, the qualifying agent, shall
is the qualifying agent for the Sole
Proprietorship, and he shall have the authority to act for the Sole Proprietorship, in all matters connected with the contracting
business; to supervise the construction and installation under the certific
ate of competency and occupational license issued to
the
Sole Proprietorship.
Print Name of Qualifying Agent
Signature of Qualifying Agent
NOTARY PUBLIC
Revised 7/6/2022
Revised 7/6/2022
Educational Prerequisite for all
Non-Examination Categories of Licensure
Each individual making application for a non-examination category of licensure, shall obtain,
previous to application, sixteen (16) hours of formal classroom training through attendance at
courses provided by Miami-Dade County approved course sponsors.
Of the sixteen (16) hours, a minimum of one (1) hour shall be required in each of the
following courses:
(a) Workplace safety/OSHA
(b) Business practices
(c) Workers’ compensation
(d) Laws and rules regulating the construction industry
Acceptable topics of these courses are shown below:
(a) Safety/OSHA topi
cs include: courses related to: OSHA safety; workplace safety
programs; safety manuals; ladders and scaffolding; electrical safety; fire safety; and
procedures for the safe use of tools and equipment.
(b) Business practice topics include: courses related to bookkeeping and accounting
practices; managing cash flow; estimating and bidding jobs; negotiating and
interpreting contracts and agreements; processing change orders; controlling
purchasing; scheduling; controlling expenses; insurance and bonding related to
construction; complying with payroll and sales tax laws; interpreting financial
statements and reports related to construction; and the Florida Construction Lien Law,
Florida Statute 713 Part I.
(c) Workers’ compensation topics include: courses related to Florida Statute 440
compliance; drug free workplace; calculating and assigning workers’ compensation
costs; premium modification and adjustments.
(d) Laws and rules topics include: courses related to Chapter 10 of the Code of Miami-
Dade County, Florida Statute 553 Part IV and other construction contracting rules and
regulations.
Miami-Dade County approved courses shall be used to s
atisfy any remaining elective hours
of required training necessary to complete the mandatory minimum of sixteen (16) hours.
These courses may include topics related to:
Trade specific knowledge
The Florida Building Code
Ethics
EPA lead renovation procedures
Construction liability insurance requirements
Contract administration and project management activities
Operation of a construction contracting firm
Revised 7/6/2022
CHECKLIST
Personal Application
Copy of Drivers License
Copy of Social Security Card
Passport Size Photograph
Notorized Experience Letter/Affidavit from a licensed
contractor and signed by the qualifier verifying required
experience AND/OR W-2's
Completed Application(s) Signed & Notarized .
Personal Credit Report (Equifax or Experian)
(Public Records Section).
Business Application
Ficticious Name Registration
Completed Application(s) Signed and Notarized
Fee(s)
Applicants Personal Credit Report
Ficticious Name Credit Report
(Dun & Bradstreet, Experian or TranUnion)
(Public Records Section)
*
INCOMPLETE APPLICATIONS WILL BE RETURNED*
If waterproofing category a certificate from a
waterproofing manufacturer.
Revised 7/6/2022