Jersey City Contractor License

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					                              OFFICE OF THE CONSTRUCTION OFFICIAL
                         30 MONTGOMERY STREET, 4™ FLOOR, RM 412
                                  JERSEY CITY, NEW JERSEY 073 02
                                (Application for Contractor's Registration)

  If application for registration is                 License
  For a Company, Partnership or a
  Corporation, the signature at the            ■               Date Filed
  Bottom of this form must be that
  Of the Principal Officer there of.                           Annual Fee

                                                               Fed. Erapl.No..

                                                               Or S.S.I. No.

 Name of Contractor (or Firm) _

 Office Address

 Business Number          "                    Home Phone

 Name and Address of Principal Officer, if applicant is a Company, partnership or Corporation.

 Classification under which registration is requested:

 Note:                              1. () General Contractor, for large building projects.
 Place Check                       2. ( ) Contractor, for small buildings and alterations.
 Mark in                           3. ( ) Roofing and Siding Contractor.
 Appropriate                       4. ( ) Demolition Contractor.
•Box.                              5. ( ) Swimming Poo! Contractor.
                                   6. ( ) Sign or Billboard Contractor.
                                   7. ( ) Miscellaneous Contractor.
Number of year's firm has been in Business                     . Number of year's firm has been
located at the above address              _.' (If firm has been at the above address for a period of
less than two years, give addresses for the previous five years'.)

Does your firm carry Liability Insurance?_
If so state amount of coverage.
Name of Company writing your Liability Insurance?

Does your firm cany Liability Insurance?
State name and license number of such Engineer or Architect.

                                       Signature of Applicant
. i


        This Power of Attorney is made on                     ' .             200
        Between the Principal (s).:

       Whose Address is:

                                              Individual referred to as "I" or "My"

       And the Agent (s):                    Raymond Meyer, or Present .
                                             Construction Official,
                                             City of Jersey City

       Whose Address is:                     30 Montgomery Street
          .   • •           .        .       Jersey City, New Jersey

      £rant of Authority: I appoint you to act as my Agent (Attorney in fact) for the following
      liinited.uijes andpurpo?es:

      Receiving and aciaiQwledging.service of any process out cf a Court of competent • be .served upon the-principal' (sj in connection with any business authorized
      »r4er Jersey City Ordinance C-655, Chapter 7 Article fl of the Jersey City Code.. The"
      liability of ffie'Construction Official shall' be limited' to forwarding any process
      documents to the principal (s) at the address.listed above.                    ■

      Signature of Principal (s)
      (To be signed in the presence of a notary)

      Sworn and Subscribed
      Before me this       day '
      Of_           ,,200       :.       "      .,

                                                                      ■   ■    •.■.!•!
                                                                                         'active Date: May ll, 2oil

.■{!                                               LICENSE AND PERMIT BOND

              KNOW ALL PERSONS BY THESE PRESENTS:                                        Bond No.           71108259-

           That w

           of the_                                                  State of New Jersey                             , as Principal,
           andWI             ■                                      luly licensed to do surety business in the State of |j

              New Jersfe->
                                                                               , as Surety, are held and firmly bound unto the

          City of Jersey City                                   ., State of New Jersey                 t as Obligee, in the penal •

          sum nf             Fifteen Thousand and 00/100                                  DOLLARS (       Si5,ooo.oo
          lawful money of the.United States, to be paid to the Obligee, for which payment well and truly to be made,
          we bind ourselves and our legal representatives,-firmly by these presents.

          .     THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, That whereas, the Principal has been.

         licensed            General Contractor                        •

                                                                                                            . by, the Obh'gee.       '

            . NOW THEREFORE, if the Principal .shall faithfully perform' the' duties and in all things comply
         with the laws and ordinances, including all amendments thereto, pertaining to the license or permit
         applied for, then this obligation to be void, otherwise to remain in full force and' effect until
              tyay H3.fch             , —2012       , unless renewed by Continuation Certificate.

            This bond may be tsrminated at'any time by the Surety upon sending notice in writing, by First'Class
        U.S. MaiLtoJije^Obligee and to the Principal at the address last known to.the Surety, and at the expiration
                        Wflays from the mailing of said notice, this bond shall ipso facto terminate and the Surety
                                                           for any acts or omissions.of the Principal subsequent to said ■
                                                       this bond shall continue in force, the number of claims made
                         bondfa3H|jthe number of premiums which shall be payable or paid, the Surety's total limit of
        ISMlty sjjall not be"Simulative from year to year.or period to period, and in no event shall the.Surety's total
        ^3[bi&|y., fO2S,afl» dagpfe^exceed the amount set forth above. Any revision of the bond amount shall not be

               Dated this        Hth ■    day of                       2011

                                                                                                                             ■ -al



                                                                                          Paul T. Bruflat, Senior Vice President
       Form 532-1-2010

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