Certificate  Renewal  Form  

Please  fill  in  your  Certificate  information  below.    (This  information  can  be  found  on  your  current  Certificate  card)  Only  a  certificate  holder  is  permitted  to  submit  changes  of  certificate  information.  

Please  indicate  any  and  all  changes     by  checking  the  “box(es)”.   Name  of  Certificate  Holder:        

Address:          

       

       

Email  Address:                

Phone:           Cell  Phone:            

                 Certificate  Number   Certificate  Type   Expiration  Date   Amount  Due     Please notarize and submit a copy of your Secure Verifiable Identification (this is your Driver License, ID Card, Passport, 1551 Permanent Resident Card, etc). You may view entire list of acceptable IDs on the Affidavit of Lawful Presence on our website: www.denvergov.org/contractor_licensing  Please  send  this  form  along  with  payment.    Fees  for  certificates  are  as  follows:  

Su pervisor-­‐  $60  Journeyman  -­‐  $40  Operator  -­‐  $40  Stationary  Engineer-­‐  $40  

Certificate  Holder's  Signature Title     Date

Community Planning & Development Office of the Manager

Contractor Licensing 201 W. Colfax Ave., Dept. 205

Denver, Co 80202 Phone: 720.865.2770

www.denvergov.org/contractor_licensing

Remit  to:   Make  checks  payable  to:     City  and  County  of  Denver   “Manager  of  Finance”     Contractor  Licensing     201  W.  Colfax  Ave.  Dept  205     Denver,  CO  80202