Get Perm 17 - Lockport

Filling out the PERM 17 - Lockport form is a crucial step in obtaining a highway work permit in New York State. This guide provides a clear and structured approach to completing the form online.

Follow the steps to successfully complete the PERM 17 - Lockport form.

1. Press the ‘Get Form’ button to obtain the document and open it for editing.
2. In the first section, enter your NYS DOT account number, if applicable.
3. Provide the legal name of the permit applicant. If using a ‘Doing Business As’ name, also include the legal entity's name and attach a copy of the certificate of conducting business under an assumed name filed in the County Clerk's Office.
4. Fill in your FEIN number, which is the Federal Employee Identification Number used by the IRS.
5. Enter the physical address of the permit applicant. This should be the principal business location. If needed, you can attach a PERM 17 ATTACHMENT sheet for additional addresses.
6. If the mailing address differs from the physical address, provide the mailing address here.
7. Input the telephone number of the permit applicant.
8. Name the contact person associated with the permit applicant.
9. For the protective liability policy, provide the policy number and the effective date, as well as the expiration date. If the coverage is continuous, indicate this and include the authorized signature of the insurance agent or broker.
10. Submit the completed certificate to the relevant NYS Department of Transportation regional office. If the work occurs in multiple regions, submit to one region and the department will coordinate acceptance.
11. Ensure the reverse side is completed, certifying the appropriate protective liability insurance coverage as per NYS Department of Transportation requirements.
12. Once completed, users can save changes, download the form, print it, or share it as needed.

Complete your documents online today for a seamless application process.