THE STATE
                 of 
                                         Department of Commerce, Community, and Economic Development 
                                                                 
                    ALASKA Division of Corporations, Business and Professional Licensing 

                                      Construction Contractors Program  
                                      PO Box 110806, Juneau, AK 99811-0806 
                             Phone: (907) 465-2550    •          Fax: (907) 465-2974 
                             Email: ConstructionContractors@Alaska.Gov 
                    Website: ProfessionalLicense.Alaska.Gov/ConstructionContractors                       

Mechanical Contractor Registration Application Instructions
    The following fees and documents must be on file with the division before the file will be reviewed: 

1) FEES
Nonrefundable Application Fee  $100
Registration Fee         $250

TOTAL FEES DUE               $350 

2) APPLICATION
Must be completed, signed and notarized (form 08-4817)
a.      Doing Business As (DBA) name;
b.      For Corporations or LLCs: Name and entity  number registered  with the Corporations section  of the
        Division.  Your business entity must be registered with the Corporations Division before your Mechanical
        Contractor Registration Application will be processed.  For information concerning these requirements,
        contact the Corporations section at Corporations.Alaska.gov;
c.      Names of all owners and principal officers or principal members;

3) INSURANCE
Proof of current general  liability insurance is required for registration (not less than $20,000 for damage to
property, $50,000 for injury, including death, to any one person, and $100,000 for injury, including death, to more
than one person).
a.      The Certificate of Insurance Coverage (form 08-4817a) included with this packet or a certificate issued
        by your provider may be accepted.

4) WORKERS’ COMPENSATION
If your business uses employee labor or your business is a Corporation or LLC, proof of workers’ compensation
insurance is required for registration.  The Workers’ Compensation Worksheet (form 08-4817c) may be used to
determine the appropriate workers’ compensation coverage required.
a.      A completed Workers’ Compensation Worksheet (form 08-4817c) is required to be submitted with the
        application; and
b.      A certificate from a  workers’ compensation insurance carrier authorized  by  the Alaska Division or
        Insurance to transact business in Alaska is required to be included with the application.

5) BONDING
A bond of $10,000.00 is required to register as a Mechanical Contractor.  One of the following must be submitted
with the application for registration:
a. Surety Bond.  Issued by an insurer or other surety company using the Construction Contractor Surety
        Bond (form 08-4817b) with the bonding company’s power of attorney included with it.  The bond form
        must be signed by both the principal (construction contractor) and the surety (bond provider); or
b. Cashier’s Check. For a cash deposit to the State of Alaska to be held in a trust account established by
        the state.
c. Time Certificate of Deposit or Savings Passbook. Issued by a bank or trust company authorized to
        do business in Alaska.  The certificate or passbook must read “State of Alaska in trust for (contractor
        name)”.  The original certificate or passbook will be held by the State.

08-4817     New 07/30/19              Instructions

! General Information 
APPLICATION PROCESSING: 
The average time to process a paper application varies by program, but can take several weeks from the date it is received in this office, complete with all 
correct forms, supporting documents and appropriate fees paid. If the application is incomplete, the applicant will be notified of the incomplete and/or incorrect 
documents and fees. When the application is complete and correct and all supporting documents have been received and all fees have been paid the license 
will be issued and sent to you with a cover letter about Alaska statutory requirements. If the application is not approved for licensure, a written explanation of 
the basis of that denial and information on how to appeal the decision will be provided. Start the process far enough in advance to allow for processing time. 
Applications are reviewed in order of receipt in our office, and walk-in customers should not expect immediate review.  
LICENSE TERM:  
There is no “inactive” status. If you choose not to renew your license, it will lapse. Licenses are issued for a two-year period and expire on September 30 of 
even-numbered years, regardless of the date of issuance, except licenses issued within 90 days of the expiration date are issued to the next biennial 
expiration date. One renewal notice will be mailed at least 30 days before license expiration to the last known address of record. If your program offers 
temporary licenses, they are issued for either 30 consecutive days or until the end of the calendar year, whichever period is shorter. 
“YES” RESPONSES: 
A “Yes” response in the application does not mean your application will be denied. If you have responded “Yes” to any professional fitness questions in the 
application, be sure to submit a signed and dated explanation, and both charging and closing court documentation. 
DENIAL OF APPLICATION: 
Please be aware that the denial of an application of licensure may be reported to any person, professional licensing board, federal, state, or local 
governmental agency, or other entity making a relevant inquiry or as may be required by law. 
RANDOM AUDIT: 
If your program requires continuing education, the Division will audit a percentage of the license renewals. If your license is randomly selected for audit, you 
will be sent a letter and required to submit copies of documentation and proof that you satisfied the continuing competency requirements as you stated on this 
renewal form.  Please note that licensees are randomly selected by computer and may be randomly selected as often as the computer program chooses. You 
must save your documents for at least four years so you can respond to audits. 
ADDRESS OR NAME CHANGE:  
In accordance with 12 AAC 02.900, it is the applicant's/licensee's responsibility to notify the Division, in writing, of changes of address or name. Name and 
address change notification forms are available on the Division’s website. The address of record with the Division will be used to send renewals and all other 
official notifications and correspondence. The name appearing on the license must be your current legal name. 
CERTIFIED TRUE COPIES:   
If any of the required documents will be issued under a former name, indicate on the application and submit marriage license and/or court documents that are 
notarized as a “certified true copy of the original document”. To obtain a certified true copy, you must present the notary with the original document along with 
the photocopy. You must write, “I certify this is a true copy of the original document” and sign your name. The notary will compare the original document with 
the copy and then notarize your signature. 
SOCIAL SECURITY NUMBERS:  
AS 08.01.060 and 08.01.100 require that a U.S. Social Security Number be on file with the Division before a professional license is issued or renewed for an 
individual. If you do not have a U.S. Social Security Number, please complete the Request for Exception from Social Security Number Requirement form 
located at ProfessionalLicense.Alaska.gov or contact the Division for a copy of the form. 
SPECIAL ACCOMMODATIONS FOR EXAMINATION: 
Programs under the jurisdiction of the Division of Corporations, Business and Professional Licensing are administered in accordance with the Americans with 
Disabilities Act. If you require a special accommodation when taking the licensing examination, you must submit an Application for Examination 
Accommodations for Candidates with Disabilities form (08-4214). 
PUBLIC INFORMATION: 
Please be aware that all information on the application form will be available to the public, unless required to be kept confidential by state or federal law. 
Information about current licensees, including mailing addresses, is available on the Division’s website at ProfessionalLicense.Alaska.gov under License 
Search. 
ABANDONED APPLICATIONS:  
Under 12 AAC 02.910, an application is considered abandoned when 12 months have elapsed since correspondence was last received from or on behalf of 
the applicant. An abandoned application is denied without prejudice. At the time of abandonment, the Division will send notification to the last known address 
of the applicant, who has 30 days to submit a written request for a refund of biennial license and other fees paid. The application fee will not be refunded. If no 
request for refund is received within that timeframe, no refund will be issued and all fees will be forfeited. 
PAYMENT OF CHILD SUPPORT AND STUDENT LOANS:  
If the Alaska Child Support Enforcement Division has determined that you are in arrears on child support, or if the Alaska Commission on Postsecondary 
Education has determined you are in loan default, you may be issued a nonrenewable temporary license valid for 150 days. Contact Child Support Services at 
(907) 269-6900, or the Postsecondary Education office at (907) 465-2962 or (800) 441-2962 to resolve payment issues.
BUSINESS LICENSES: 
The status of a professional license will directly impact the status of an associated business license. Renewal applications for business licenses are mailed 
separately. For more information about business licenses, call (907) 465-2550 or online at:  BusinessLicense.Alaska.gov 
STATUTES AND REGULATIONS:  
The complete set of statutes and regulations for this program are available by written request or online at the Division’s website: 
ProfessionalLicense.Alaska.Gov 
If you would like to receive notice of all proposed regulation changes for your program, please send a request in writing with your name, preferred contact 
method (mail or email), and the program you want to be updated on to: 
                                                    REGULATIONS SPECIALIST 
                                           Email: RegulationsAndPublicComment@Alaska.Gov 
                                           Department of Commerce, Community, and Economic Development  
                                           Division of Corporations, Business and Professional Licensing 
                                                    P.O. Box 110806, Juneau, Alaska 99811-0806 

08-4817            New 07/30/19                         General Information 

        THE STATE                                                                            CON 
               of                                                     FOR DIVISION USE ONLY 
                 ALASKA 
        Department of Commerce, Community and Economic Development 
        Division of Corporations, Business and Professional Licensing 

Construction Contractors Program    
PO Box 110806, Juneau, AK  99811-0806 
Phone: (907) 465-2550    •  Fax: (907) 465-2974 
Email: ConstructionContractors@Alaska.Gov 
Website: ProfessionalLicense.Alaska.Gov/ConstructionContractors 

Mechanical Contractor Registration Application 

PART I  Payment of Fees
New Application:                   Nonrefundable Application Fee ($100) + License Fee ($250) $350 

Owner/Entity Change:               Nonrefundable Application Fee ($100) + License Fee ($250) $350 

PART II  Registration Information

Doing Business As (DBA): 
Reminder: If you are a corporation or LLC your business entity must be registered with the Corporations Division before this application is processed. 

Mailing Address: 

Contact Phone Number: 

EMAIL AGREEMENT: By choosing to receive correspondence on any matter affecting my license or other business with the Alaska Division of 
Corporations, Business and Professional Licensing, I agree to maintain an accurate email address through the MY LICENSE web page. I understand 
that failure to check my email account or to keep the email address in good standing may result in an inability to receive crucial information, potentially 
resulting in my inability to obtain or maintain licensure.

Email Address: 

 Are you a Corporation, LLC, LP or LLP?                         YES           NO               If YES, provide:    

Name of Corporation or LLC: 

Entity Number: 

Are you changing the Owner or Entity name on an existing license?          YES           NO    If YES, provide: 

License Number: 

08-4817            New 07/30/19  Application Page 1 of 3

PART III  Ownership

Check the applicable box and provide the complete name(s) of the owner(s) including all partners, corporate officers, or 
managing members, whichever is appropriate; and provide U.S. Social Security Numbers for sole proprietor or partners. 

        Sole Proprietorship    Partnership Corporation                                        LLC 

        Full Name              Address     Date of Birth                           Social Security # 
                                           (sole proprietorship/partners only)  (sole proprietorship/partners only) 

PART IV  Insurance

Give proof of current general liability insurance to register as a Mechanical Contractor. AS 08.18.101(a)(2) & (b) 

I have completed the attached Certificate of Insurance Coverage (form 08-4027a) or a certificate issued by my 
provider to  this application as proof of public  liability and property damage insurance covering contracting 
operations in this state in the sum of not less than $20,000 for damage to property, $50,000 for injury, including 
death, to any one person, and $100,000 for injury, including death, to more than one person.  

PART V  Workers’ Compensation

         I have completed the Workers’ Compensation Worksheet and included it with this application.  

Is the documentation/certificate showing workers compensation included in this application?       YES       NO 

If NO, please state the reason (i.e. sole proprietor with not employees, etc.): 

08-4817   New 07/30/19         Application Page 2 of 3

PART VI  Bonding

A bond of $10,000.00 is required to be registered as a Mechanical Contractor pursuant to AS 08.18.071. 
Please check the appropriate boxes below: 

       I have provided original documentation or a copy of my surety bond (form 08-7027b). 

       I have provided an original Time Certificate of Deposit or Savings Passbook issued by a bank or trust 
       company authorized to do business in Alaska.  The certificate or passbook must read “State of Alaska in 
       Trust for (contractor name).” 

       I have provided a cashier’s check for a cash deposit to the State of Alaska to be held in a trust account 
       established by the state. 

PART VII  Mechanical Administrator  –  A mechanical administrator assignment is required.

Mechanical Administrator Name: 

Mechanical Administrator License #: 

PART VIII 

I hereby certify that I am the person herein named and subscribing to this application and that I have read the 
complete application, and I know the full content thereof. 

I declare that all of the information contained herein and evidence or other documents submitted herewith are true 
and correct. 

I understand that any falsification or misrepresentation of any  item or response in this  application, or  any 
attachment hereto, or falsification or misrepresentation of documents to support this application,  is sufficient 
grounds for denying, revoking, or otherwise disciplining a license or permit to practice in the state of Alaska. 

I further understand that it is a Class A misdemeanor under Alaska Statute 11.56.210 to falsify an application and 
commit the crime of unsworn falsification. 

                                 Notarized Signature of Owner, Corporate Officer, or Member: 
Notary Stamp 

                                 Printed Name of Owner, Corporate Officer, or Member: 

Notary’s Signature:                                        My Commission Expires: 

Subscribed and Sworn to                                                                
                                                                  State of:
Before me on this Day: 

08-4817        New 07/30/19                Application Page 3 of 3

               THE STATE
               of 
                                        Department of Commerce, Community, and Economic Development 
                        ALASKA Division of Corporations, Business and Professional Licensing 

                                 Construction Contractors Program  
                                 PO Box 110806, Juneau, AK 99811-0806 
                                 Phone: (907) 465-2550    •        Fax: (907) 465-2974 
                                 Email: ConstructionContractors@Alaska.Gov 
                        Website: ProfessionalLicense.Alaska.Gov/ConstructionContractors 

Certificate of Insurance Coverage

Submit this completed original form or a Certificate of Insurance issued by your provider with the Construction 
Contractor Application. 

This is to certify that we are a duly authorized casualty insurer eligible to write business in the State of Alaska and have 
written a public liability policy of not less than the limits required under AS 08.18 on behalf of,  

(sole proprietor or all partners’ names or corporation name) 

DBA:     

for registration as a construction contractor, under policy number(s) 

effective from                    to                                    .  

In the event the above policy is cancelled for any reason, we agree to furnish the Department of Commerce, Community, 
and Economic Development, Construction Contractor Section at the above address, a notification of cancellation at least 
30 days before the effective date of that cancellation. 

                                                              Name of Insurance Carrier (not agency) 

                                                              Address 

                                                              City                 State                    ZIP Code 

                                                              Signature of Authorized Agent 

                                                              Date 

08-4817a         New 07/30/19            Certificate of Insurance Coverage 

                   THE STATE
                   of 
                                             Department of Commerce, Community, and Economic Development 
                                             Division              of Corporations, Business and Professional Licensing 
                    ALASKA                         
                                    Construction   Contractors Program                    
                                    PO Box 110806, Juneau, AK 99811-0806 
                                    Phone: (907) 465-2550    •        Fax: (907) 465-2974 
                                    Email: ConstructionContractors@Alaska.Gov 
                           Website: ProfessionalLicense.Alaska.Gov/ConstructionContractors 

Mechanical Contractor Surety Bond - Required by Construction Contractor Statute AS 08.18.07

Bond Number __________________________________

KNOW ALL MEN BY THESE PRESENTS that                                   ________ 
Doing business as (DBA)             ___________ 
as principal, and  
as Surety, are held firmly bound to the State of Alaska, in the sum of TEN THOUSAND DOLLARS ($10,000) lawful money of 
the United States, for the payment of which, well and truly to be made, we and each of us, bind ourselves, our heirs, executors, 
administrators, successors and assigns, jointly and severally, firmly by these presents. 
THE CONDITIONS OF THE ABOVE OBLIGATIONS ARE SUCH THAT: Whereas, the above bound principal has applied to, 
or is about to obtain from, the State of Alaska for registration as a Mechanical Contractor pursuant to AS 08.18.011 and the 
acts amendatory thereof and supplemental thereto: 
NOW THEREFORE, if the State of Alaska shall register the above bounden Principal as a Mechanical Contractor and that 
Principal shall faithfully  and honestly  act a  Mechanical  Contractor  in  accordance  with  law, and fully complies with the 
provisions of AS 08.18.071 of the State of Alaska and acts thereof and supplemental thereto, and if the Principal shall fully 
indemnify and save harmless from loss the State of Alaska and any person who may have cause of action against the Principal 
for any malfeasance or misfeasance in the conduct of a Mechanical Contractor, then this obligation to be voided, otherwise 
to remain in full force and virtue. 

LIABILITY UNDER THIS BOND commences ____________________ and shall be continuous until the registration license 
is revoked or otherwise terminated  by the Department of Commerce, Community,  and  Economic Development, State of 
Alaska (the Department) or until written notice from the Surety is received by the Department provided the bond has been 
cancelled for lawful reasons.  The Bond shall apply to all liens and liabilities which arise during the effective period of the bond 
to which the bond is applicable under law, even if the judgment liens are foreclosed or valid liens settled after the effective 
period of the bond or liabilities are enforced after the effective period of the bond. 

IN WITNESS WHEREOF, the principal and surety have signed and sealed this bond on this day, the ________________ of 
____________________________________________, 20________. 

PRINCIPAL (Applicant) 

 Name: 

 Title:                                                                             Signature: 

SURETY 
                                                     Attorney-in-
Name: 
                                                                      fact: 
Agency Name: 

 Address: 

THIS BOND IS NOT VALID UNTIL SIGNED BY BOTH PRINCIPAL AND SURETY.  
Surety's Power of Attorney must be attached. 
                                                                                                 (Surety's Seal) 

08-4817b             New 07/30/19            Surety Bond

                      THE STATE
                      of 
                                            Department of Commerce, Community, and Economic Development 
                                            Division              of Corporations, Business and Professional Licensing 
                         ALASKA 

                                     Construction Contractors Program  
                                     PO Box 110806, Juneau, AK 99811-0806 
                                     Phone: (907) 465-2550    •      Fax: (907) 465-2974 
                                     Email: ConstructionContractors@Alaska.Gov 
                          Website: ProfessionalLicense.Alaska.Gov/ConstructionContractors          

Workers’ Compensation Worksheet

Doing Business As (DBA): 
                                                  If applying for an initial registration please note pending. 
Construction Contractor License #: 

If your business uses employee labor, or if your business is a corporation or LLC, you must provide proof of workers 
compensation insurance by a certificate of insurance issued by a carrier authorized by the Alaska Division of Insurance to 
transact business in Alaska.  This certificate must include the following six items: 1) name of the insured exactly as licensed, 
2) the DBA, 3) name of the insurance provider, 4) policy number, 5) commencement date and 6) expiration date.
A policy with “AOS” or “All Other States” endorsement will only be accepted if the certificate specifically states “covers 
activities in Alaska. 

Are you a sole proprietor or partnership and you have employees?                                   YES           NO    

Are you a Limited Liability Company (LLC) or Corporation and you have employees?                   YES           NO    
Please note: There are no exemptions for family, friends, or non-residents, or for part-time or temporary jobs.  Do not classify workers 
as “independent contractors” without calling the Alaska Workers’ Compensation Division Special Investigations Unit at 907-269-4002. 

    If YES to either of the above questions, then please check the appropriate box below: 

Sole Proprietorship 
I am a sole proprietor and have workers compensation insurance coverage for all my employees, excluding myself 
as the owner; and I have attached the necessary certificate to this application. 
I am a sole proprietor and have workers compensation insurance coverage for all my employees including myself; 
and I have attached the necessary certificate to this application. 

Partnership 
We are a partnership and have workers compensation insurance coverage for all employees, excluding the owners; 
and we have attached the necessary certificate to this application. 
We are a partnership and have workers compensation insurance coverage for all employees including the owners; 
and we have attached the necessary certificate to this application. 

Limited Liability Company (LLC) 
We are an LLC and have workers compensation insurance coverage for all employees excluding any members who 
own 10% or greater of this company (members who own 9% or less are required to be covered by workers 
compensation insurance); and we have attached the necessary certificate to this application. 

Corporation 
We are a Corporation and have workers compensation insurance coverage for all employees excluding any officers 
or members who own 10% or greater of this company (officers or members who own 9% or less are required to be 
covered by workers compensation insurance); and we have attached the necessary certificate to this application. 

08-4817c                New 07/30/19 Workers' Compensation Worksheet

              THE  TATE S                                                                                                  FOR DIVISION USE ONLY 
                of 
                  ALASKA 
              Department of Commerce, Community, and Economic Development 
              Division of Corporations, Business and Professional Licensing 

        State of Alaska 
        Department of Commerce, Community, and Economic Development 
        Division of Corporations, Business and Professional Licensing 
        PO Box 110806, Juneau, AK 99811 
        Phone: (907) 465-2550 

Credit Card Payment Form 

All major credit cards are accepted. For security purposes, do not email credit card information. 
Include this credit card payment form with your application.  

Name of Applicant or Licensee:      _________________________________________________________________________________________________________________________ 

Program Type:   ________________________________________________________       License Number (if applicable):                      ________________________________ 

 I wish to make payment by credit card for the following(check all that apply):                                                                    AMOUNT    

        Application Fee:  _________________________________________________________________________________________________                __________________________ 

        License or Renewal Fee:     _________________________________________________________________________________                      __________________________ 

        Other (name change, wall certificate, fine, duplicate license, exam, etc.):        

           1. _____________________________________________________________________________________________________________________ __________________________ 

           2. _____________________________________________________________________________________________________________________        __________________________

                                                                                               TOTAL:            ___________________________ 

Name (as shown on credit card):   ________________________________________________________________________________________________________________________ 

Mailing Address:            ___________________________________________________________________________________________________________________________________________________ 

Phone Number:   ________________________________________________________      Email (optional):               _______________________________________________________ 

Signature of Credit Card Holder:              _____________________________________________________________________________________________________________________ 

 08-4438                   Rev 12/26/18                   Credit Card Payment Form (all major cards accepted) 

   CREDIT CARD INFO:  Your payment cannot be processed unless all fields are completed! 

   1.    Account Number:                                                                                      All four fields MUST 
                                                                                                                                    be completed! 
   2.    Expiration Date:
                                                                                                              This section will be 
   3.    Billing ZIP Code:
                                                                                                              destroyed after the 
   4.    Security Code:                                                                                       payment is processed.