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Business License Application

  1. Additional Information

    Based on the type of business license selected, additional information may be requested by the Administration Office and additional paperwork may be required for a specific license.

  2. Proof of Workers' Compensation Insurance

    Minnesota Statute Section 176.182 requires every state and local licensing agency to withhold the issuance or renewal of a license or permit to operate a business in Minnesota until the applicant presents acceptable evidence of compliance with workers' compensation insurance coverage requirement of Section 176.181 Subd. 2.  The information required is:

    - the name of the insurance company

    - the policy number

    - dates of coverage

    - or the permit to self-insure

    This information will be collected by the licensing agency (the City) for the records file.  It will be furnished, upon request, to the Department of Labor and Industry to check for compliance.

    This information is required by law, and licenses and permits to operate a business may not be issued or renewed if it is not provided and/or falsely reported.  Furthermore, if this information is not provided and/or falsely reported, it may result in a $1,000 penalty assessed against the applicant by the Commissioner of the Department of Labor and Industry payable to the Special Compensation Fund.

    Provide the information specified above in the spaces provided, or certify the precise reason your business is excluded from compliance with the insurance coverage requirement for workers' compensation.

  3. Or I am not required to have workers' compensation liability because:
  4. Insurance Information

    I have read and understand my rights and obligations with regards to business licenses, permits and workers' compensation coverage, and I certify that the information provided is true and correct.

  5. Electronic Signature Consent

    By electronically signing the Business License Application, the applicant consents the e-signature legally binds them to the terms and conditions of the application.

  6. Leave This Blank:

  7. This field is not part of the form submission.