Competency Card Application

2. COMPETENCY CARD PROCEDURES
   To reciprocate exam scores into Sumter County, complete the application below and supply the following:
4. 1. Letter of Reciprocity

   Letter of reciprocity sent directly to Sumter County Building Services at 7375 Powell Rd, Suite 115, Wildwood, FL 34785 or emailed to the Building Department from the reciprocal County or Municipality in Florida that sponsored your original examinations. The letter shall verify the testing facility used, examination taken for the trade with a minimum grade of 75%, and Business and Law with a minimum grade of 75%. Grandfathering without testing is not acceptable.

6. 2. Fees - $100

   Credit card, cash, check, or money order payable to the BOCC Sumter County. Check must contain your address and phone number. If choosing to pay by credit or debit card Sumter County Building Services will contact you for payment.

   1. Cash
   2. Check/Money Order
   3. Credit/Debit Card
8. 3. Credit Report and Financial History
   The credit report must indicate all credit activity of records for the applicant and include the previous four years, and if applicable, the applicant's business. This report shall be submittted directly to the County by the applicable credit agency or bureau. Additionally, the applicant must disclose any bankruptcy proceedings in which the applicant or a business owned or controlled by the applicant has been a part of within the last ten years.
10. Construction Industry Licensing Board Credit Reporting Agencies
    List of Credit Reporting Agencies
12. 4. Liability and Worker's Compensation Insurance
    Proof of insurance in general, building, and electrical contractors is $300,000/general liability and $50,000/property damage. All other license categories require $100,000/general liability insurance and $25,000/property damage. The applicant must provide proof of worker's compensation insurance and/or worker's compensation exemption as required by Florida Statutes. All certificates of insurance must be in the EXACT NAME of the business being qualified and list Sumter County Building Services, 7375 Powell Road, Wildwood, FL 34785, as the certificate holder.

14. Please have your insurance company directly email the Building Department or fax (352-689-4401) current workers’ compensation and general liability insurance certificates to the following as the certificate holder:

    Sumter County Building Services
    7375 Powell Rd., Suite 115
    Wildwood, FL 34785

16. Worker's Compensation Exemption Form (if applicable) from the Department of Financial Services
18. 5. Copy of the current State license issued by the Department of Business and Professional Regulation (if applicable)
20. COMPETENCY CARD APPLICATION
22. The completed application and required supporting documentation shall be evaluated within ten (10) business days after receipt. Reciprocity Competency Card Applications shall have a final determination by the Building Official within seven (7) business days following the review period. Failure to submit a complete application with supporting documentation will result in a delay of the processing of your application.
24. F.S. 489 Part I & Part II Trade Categories: Check which trade pertains (Only one field may be selected per application)
26. Trades Requiring Registration with the State*

    1. N/A
    2. Air Conditioning "A"
    3. Air Conditioning "B"
    4. Building

    1. Commercial Pool/Spa
    2. Electric
    3. Electrical Sign
    4. General

    1. Mechanical
    2. Plumbing
    3. Residential
    4. Residential Pool/Spa

    1. Roofing
    2. Sheet Metal
    3. Specialty Structure
28. Special*

    1. N/A
    2. Carpentry
    3. Concrete Masonry

    1. Concrete Placing & Finishing
    2. Drywall
    3. Garage Door Installation

    1. Irrigation
    2. Masonry

    1. Sign ( non-electrical)
    2. Stucco, Lath & Plastering
30. Company Name*
32. Business Address*
34. City*
35. State*
36. Zip*
38. Phone*
39. Cell*
41. Fax*
42. Email*
44. State Registration Number*
45. FEIN No.*
47. United States Citizen*

    1. Yes

    1. No
49. Current Employer*
50. Phone*
52. Address*
54. Position Held*
55. Length of Employment*
57. List the COUNTIES and/or CITIES you hold a competency card in and the competency card number(s).
59. County/City
60. Competency Card No.
62. County/City
63. Competency Card No.
65. County/City
66. Competency Card No.
68. CHECK WHICH OF THE EDUCATION/EXPERIENCE REQUIREMENTS FOR WHICH YOU QUALIFY
70. An associate degree from an accredited two-year college in the appropriate field of engineering, architecture, or building construction (Please attach a copy of official transcript or a copy of diploma) and a minimum of two (2) years of proven experience in the category in which you seek to qualify for.

    1. Yes
72. Copy of transcript or diploma
74. OR
76. A minimum of four (4) years of active experience as a workman who has learned the trade by serving as an apprentice and skilled workman in that particular trade for a minimum of one (1) year, or who has served as a foreman in charge of a group of workmen for a minimum of one (1) year.

    1. Yes
78. FINANCIAL RESPONSIBILITY/BACKGROUND QUESTIONS
    Indicate your response by CHECKING "YES" or "NO" to any of the questions below, if you answer Yes to any of the questions you must provide an explanation. The QUALIFYING AGENT must answer and sign the financial responsibility questionnaire:
80. Question 1 - Have you ever been refused a Certificate of Competency or other professional license, or had such a license suspended or revoked in the State of Florida or any other State?*

    1. Yes

    1. No
82. Question 2 - Have you during the past five years had more than three business complaints filed against you or a business you owned or managed, through a trade association, A Better Business Bureau or other non-governmental agency?*

    1. Yes

    1. No
84. Question 3 - Has any federal, state, county or other governmental agency filed and business, civil, or criminal complaints against you during the past five years*

    1. Yes

    1. No
86. Question 4 - Have you ever failed to complete a construction contract?*

    1. Yes

    1. No
88. Question 5 - Are there any outstanding labor or material liens against you or your company?*

    1. Yes

    1. No
90. Question 6 - Have you been charged with or convicted of acting as a contractor without a license by any state, county or municipality?*

    1. Yes

    1. No
92. Question 7 - Have you as a licensed contractor in this or any other state been subject to any disciplinary action by state, county or municipality?*

    1. Yes

    1. No
94. If you answered Yes to any of the above questions, please indicate each question number and explain:
96. Identification*
    Submit a clear copy of your driver's license or a state identification card with photograph.
98. Corporation of Fictitious Name
    If you are a qualifying as a corporation or a fictitious name, you must furnish proof.
100. Copy of State license issued by the Department of Business and Professional Regulation
102. STATEMENT OF QUALIFIER'S RESPONSIBILITY
     In making application to qualify as a sole proprietor, partnership, or corporation, I understand that I, as qualifying agent and/or Financial Officer, am completely responsible for the actions of said entity as they relate to its construction business. I will actively supervise all construction work and be responsible for ascertaining all such work is complete according to approved plans, applicable codes, and good construction standards. I will immediately notify the Sumter County Building Official if I sever connections with the partnership or corporation concerned in this application, or I am no longer actively supervising the construction work. Further, I understand that the Sumter County Building Official, by the authority granted to it in Ordinance 2018-06, holds the qualifying agent and/or Financial Officer responsible for the supervision of the job sites as well as all financial aspects of the entity's construction business including, but not limited to, payment to suppliers, payment to employees, and payment of applicable federal and state taxes.
104. Name of Company:*
106. Title/Position in the firm:*
108. Print Name of Qualifying Agent*
110. Print Name of Financial Officer*
112. Construction Industry Licensing
     Submission to authorize Sumter County to complete a criminal background search at federal, state and county levels.
114. 1) Screening Questionnaire
116. License Holder Information:
118. Last Name*
119. First Name*
120. Middle Name*
122. Address*
124. City*
125. State*
126. Zip Code*
128. Date of Birth*
129. Driver License Number*
130. State*
132. Social Security Number*
134. Previous Residences (past 5 years)
136. Address
137. Dates
139. Criminal History
141. Have you ever been charged with or convicted of any criminal offense (other than minor traffic violations), or are currently being prosecuted for any criminal offense.*

     1. Yes
     2. No
143. Have you ever received Pre-Trial Intervention or Deferred Prosecution for any criminal offense*

     1. Yes
     2. No
145. Note: If you answered yes to either of the above questions, please provide a brief description of the charges and the outcome of the case.
147. Please Note: The existence of a criminal history will not necessarily preclude you from obtaining a Certificate of Competency in Sumter County.
149. 2) Authorization & General Release:
151. I hereby authorize Sumter County Development Services, and all of its agents (MAF Background Screening) to request and receive any information and records concerning me, including but not limited to consumer credit, criminal record history, worker's comp., driving , employment, military, civil and educational data and reports, from any individuals, corporation, partnerships, associations, institutions, schools, governmental agencies and departments, court law enforcement and licensing agencies, consumer reporting agencies and other entities, including my present and previous employers.
153. I further release and discharge Sumter County Development Services, all of its agents (MAF Background Screening subsidiaries and affiliates, and every employee or agent of them), and all individual and personal, business, private or public entities of any and all claims and liability arising out of any request(s) for, or receipt of, information or records pursuant to this authorization, or arising out of any compliance, or attempted compliance, with such request(s). I also authorize the procurement of an investigative consumer report and understand that it may contain information about my character, general reputation, personal characteristics, and mode of living, whichever are applicable.
155. I understands I have the right to make a written request within a reasonable period of time to MAF for a complete and accurate disclosure of additional information concerning the nature and scope of the investigation. I further understand that MAF's reporting of information pursuant to the Fair Credit Reporing Acts is not intended to authorize or condone a prospective employer's request for and reliance upon information for purposes that are not legitimate under the Fair Credit Reporting Act or any federal or state employment laws. I acknowledge I have voluntarily provided the above information for Contracting Licensing purposes, and I have carefully read and understand this authorization.
157. Name*
158. Date*
160. NOTICE OF PURPOSE OF REQUEST FOR SOCIAL SECURITY NUMBER
     Sumter County collects your social security number, or a portion thereof, for one or more of the following purposes: classification of accounts, identification and verification; credit worthiness; billing and payments; data collection; reconciliation and tracking; payroll and benefit processing; tax reporting; new utility accounts applications; bank draft authorizations; vendor registration applications; Contractor Licensing; volunteer contracts or other volunteer assistance; criminal background checks; emergency transport for billing and insurance; and verification of identity.
162. Staff Only
164. Received by
165. Date
167. Appeals: Necessity of Record
     Any person who decides to appeal any decision made by the Construction Licensing Board shall be required to supply a verbatim record of the proceedings. The licensing board assumes no responsibility for furnishing records.
169. ONCE ALL OF THE APPLICABLE STEPS ABOVE ARE COMPLETED, THE LICENSE WILL BE IN "ACTIVE" STATUS AND THE APPLICANT WILL BE ABLE TO PERFORM WORK IN THEIR TRADE.
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171. 1. Receive an email copy of this form.
172. Email address

     This field is not part of the form submission.

173. Submit

* indicates a required field