AFFIDAVIT OF CONTRACTOR LICENSE AND BONDING
Permit No.
Permittee: Check one of the following:
[ ] Contractor [ ] Architect / Engineer [ ] Owner [ ] Other:
Declarations: CONTRACTORS shall provide the following information:
I hereby affirm that the permittee is currently licensed under the provisions of ARS Title 32, Sec. 32-1101 through Sec. 32-1198.
Company Name: phone:
Address:
Contractor's Lic. No. _______________________
State TPT Tax Lic. No. (if not MRRA): ________________
EXEMPTION: Those qualifying for exemptions from ARS Title 32, Sec. 32-1 101 through Sec. 32-1198, shall check
the appropriate box below. Please see: Who Needs To Place A Bond With The Arizona Department of
Revenue : https://azdor.gov/sites/default/files/media/PUBLICATION_2018_539.pdf
I hereby affirm that the permittee is EXEMPT from licensing for the following reason:
[ ] Governmental. Agency of the U.S. Government, State of Arizona, County, Municipality
or Political Subdivision. (ARS Sec. 32-1121.A. l)
[ ] Owner / Builder. Improving owner(s) property themselves or jointly with licensed contractors and said
improvements are not for sale or rent. (ARS Sec. 32-1121.A.5)
[ ] Residential Owner. Owner(s) of residential property using only licensed contractors. (ARS Sec. 32-1 I 21.A.6)
[ ] Architect / Engineer. Engaging in professional practice as defined in ARS Title 32 Chapter I, and not
engaging in contracting. (ARS Sec. 32-1121.A.7)
[ ] MRRA Contractor. Not a prime contractor. Engaging in contracting that qualifies as "MRRA".
[cont.]
Bonding Information: I (am) (am not) a prime contractor on this project.
Only if you are a prime contractor, the following information is required:
1. YES___ NO___ Do you have a principal place of business in this state?
A “principal place of business” means a location where a person has continuously operated a
facility with a least one full-time employee for the preceding twelve months.
2. Yes___ NO___ Will the total gross receipts for your contract be less than $50,000?
If the answer to BOTH of the questions above is ‘NO’, you must obtain a certificate from the Director of the Arizona
Department of Revenue or the Director’s agent that the requirements have been met before permit(s) can be issued.
Contact DOR at 602-716-6056 or email [email protected].
NOTE: The department may require a taxpayer that is delinquent in payment of Arizona tax to post a bond.
The department may also require a taxpayer that has had a history of delinquency for a previous
business license to post a bond for payment of tax (transaction privilege, withholding, or corporate).
(Ref: ARS Sec. 42-1102, 42-5006, 42-5007 and Def: ARS Sec 42-1101.01, 42-5001)
Signature: Date: __________________
Permittee or Authorized Agent
Resources:
42-5006 Taxpayer bonds; out of state licensed contractors and manufactured building dealers
https://www.azleg.gov/viewdocument/?docName=https://www.azleg.gov/ars/42/05006.htm
42-5007 Taxpayer security; out-of-state prime contractors; definition
https://www.azleg.gov/viewdocument/?docName=https://www.azleg.gov/ars/42/05007.htm
42-5075 Prime contracting classification; exemptions; definitions (look for subsection O)
https://www.azleg.gov/viewdocument/?docName=https://www.azleg.gov/ars/42/05075.htm
42-1102: https://www.azleg.gov/viewdocument/?docName=https://www.azleg.gov/ars/42/01102.htm
42-5006: https://www.azleg.gov/viewdocument/?docName=https://www.azleg.gov/ars/42/05006.htm
42-5007: https://www.azleg.gov/viewdocument/?docName=https://www.azleg.gov/ars/42/05007.htm
42-1101.01: https://www.azleg.gov/viewdocument/?docName=https://www.azleg.gov/ars/42/01101-01.htm
42-5001: https://www.azleg.gov/viewdocument/?docName=https://www.azleg.gov/ars/42/05001.htm
COMMUNITY DEVELOPMENT BUILDING SAFETY
31 E 5th Street, Garden Level East Tempe, AZ 85281 (480) 350-8331 or (480) 350-8400 TDD
[email protected]
