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CITY OF EAGLE Contractor Registration Verification Form Name of Individual: Name of Business: Business Address: Telephone Number: Contractor Registration Number: Expires: If you are exempt from obtaining a contractor registration number pursuant to Idaho Code 54- 5205, write “exempt” in the registration number field. I acknowledge that I am in compliance with the Idaho Contractor Registration Act, Title 54, Chapter 52, of the Idaho Code. If I claim an exemption from obtaining a registration number, I acknowledge that it is my duty to determine if I actually qualify for such exemption. Such duty may include consultation with legal counsel. If I claim an exemption, I will notify the City of Eagle immediately if I cease to qualify for such exemption. If I do not claim an exemption, I will notify the City of Eagle immediately if I fail to renew my contractor registration or if such registration is revoked or suspended. I further acknowledge that I am required to verify contractor registration numbers for all subcontractors that I employ unless such subcontractor qualifies for an exemption. I understand that a willful violation of the Idaho Contractor Registration Act, to include but not limited to, providing a false registration number, claiming a false exemption status or hiring unregistered subcontractors that do not qualify for exempt status may result in the immediate suspension or revocation of any building permit issued to me by the City of Eagle that was obtained pursuant to such violation. Such suspension or revocation is in addition to the penalties prescribed in Idaho Code 54-5217, which can include a fine up to $1,000. and/or six months in jail. Date: Signature: Print Button