Contractor Application Form - Community Contacts Inc

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Federal ID Number *

Date of Organization *

STATEMENT OF QUALIFICATIONS TO BE SUBMITTED BY CONTRACTOR

Questions must be answered and the information must be clear and comprehensive. The contractor may submit any additional information if he/she desires.

Name of Legal Entity *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Office Phone *

Fax

Business Type *

Contractor and/or Principal Name *

First

Last

Mobile Phone

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Add additional names?

Background and experience of the principals in your firm, including the officers: *

How many years have you been engaged in the contracting business, under your present form or trade area?

Have you ever filed for bankruptcy?

Project References

List the most important projects recently completed by your Company and who the work was performed for. State the approximate cost of each and month and year completed.

Project #1: Name

Project #1: Location

Phone

Employer

Amount of Contract

Date of Completion

Project #2: Name

Project #2: Location

Phone

Employer

Amount of Contract

Date of Completion

Business References

Please include primary bank and at least 2 suppliers

Bank Name

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Account Number

Supplier 1:

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Account Number

Supplier 2:

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Account Number

Supplier 3

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Account number

Please list subcontractors used in the past.

What licenses do you currently hold in the State of Illinois?

Roofing license number

Lead paint

Lead contractor license number

Others

Please describe the lead contractors experience in lead abatement or interim control work (include required certifications or licenses)

Minimum limits of insurances

Contractor shall maintain limits no less than:

a. Comprehensive Public Liability: not less than $1,000,000 for injuries, including accidental death to any one person, per accident and $1,000,000 in the aggregate for policy term.

b. Automobile Liability: for injuries or damages caused by the Contractor’s vehicle on the job site, a minimum combined single liability limit of $500,000.

c. Workers’ Compensation and Employers Liability: Insurance covering all employees meeting statutory requirements in compliance with the applicable state and federal laws not less than $100,000 per person for employers’ liability. No exclusions.

d. Any additional insurance required for certification as a lead licensed contractor including pollution liability insurance.

Please upload certificate of insurance *

Description of Operations/LocationsNehicles/Exclusions added by Endorsement / Special Provisions shall include or some form of: Per the written contract, Illinois Housing Development Authority (IHDA), Community Contacts Inc. (CCI) and Housing Continuum Inc. (HCI), are endorsed as primary and non-contributory additional insured’s. IHDA, HCI and CCI are also endorsed for waiver of subrogation on the above mentioned general liability and workers compensation policies.

Limits can change based upon project criteria

The Contractor represents that the following persons are authorized to sign and/or negotiate contracts and related documents to which the bidder will be duly bound:

Name and Title

Phone

BY CLICKING ACCEPT, A DULY AUTHORIZED OFFICER OR EMPLOYEE, HEREBY CERTIFIES THAT THE ABOVE INFORMATION IS TRUE AND CORRECT. FUTHERMORE HEREBY GIVES PERMISSIONS TO HAVE THE CREDIT INFORMATION RELEASED TO COMMUNITY CONTACTS, INC & HOUSING CONTINUUM , INC. AND HAS HEREUNTO SET HIS SIGNATURE

Accept and continue

CONTRACTOR REQUIREMENTS: ALL ELIGIBLE CONTRACTORS SHALL BE REQUIRED TO:

• Obtain and pay for all permits and licenses necessary for the completion and execution of the work and labor to be performed.

• Perform all work to conform to applicable local codes and requirements.

• Abide by Federal and Local regulations pertaining to equal employment.

• Keep the premises clean and orderly during the course of the work and remove all debris at the completion of the work. Materials and equipment that have been removed and replaced as part of the work shall belong to the Contractor, unless the Homeowner and the Contractor makes a prior agreement.

• Not assign the contract without prior consent of the Homeowner. The request for assignment must be addressed in writing to and approved by the Rehabilitation Specialist.

• Guarantee the work performed to be free from defect for a period of one year from the date of final acceptance of all of the work required by the contract. Furthermore, the Contractor must furnish the Homeowner, with all manufacturers and suppliers’ written guarantees and warranties covering the materials and equipment furnished under the contract.

• Provide or provide for, on-site supervision of Sub-Contractors and/or their employees.

• No Contractor shall be accepted to the program if they are on the H.U.D. debarred list.

PROBATIONARY APPROVAL

Contractor’s, who are deemed qualified, based upon information obtained, shall be placed on the eligibility list under a probationary status. They shall remain on the probationary status until they have successfully completed two (2) rehabilitation jobs.

SUSPENSION OR REMOVAL OF CONTRACTORS FROM THE QUALIFIED LIST

Contractors may be removed temporarily or permanently from the approved list. A Contractor may be deleted from the list for one or more of the following reasons:

• Continuously poor quality work as determined by the Rehab. Specialist.

• Failure to maintain the proper insurance and keep CCI/HCI updated.

• Failure to pay Sub-Contractors or Suppliers.

• Failure to respond to a minimum of two (2) consecutive requests for bids. In such instances, the Contractor shall be suspended for a period of six (6) months, commencing on the day the second non-responsive bid is opened.

• Failure to respond to complaints of the Homeowners, as determined valid by the Rehab. Specialist.

• Contractor’s insolvency, bankruptcy or other conduct or condition which has resulted in a monetary loss to a Homeowner or the Rehabilitation Program in connection with the contract work.

• Contractor’s conviction of a crime in connection with the contract work or in connection with payment or receipt of funds administered by the Rehabilitation Program.

• Failure to maintain current license and registrations, if applicable.

• Contractor’s continual agreement to make additions or changes with the Homeowner without prior approval from Community Contacts, Inc & Housing Continuum, Inc.

• Failure to provide on-site supervision for Sub-Contractors or their employees.

• If a Contractor believes his/her name has been unjustly removed from the bidders list he/she may request an informal hearing on the determination. The request must be made in writing within ten (10) days of notification that his/her name has been removed from the list.

Name *

First

Last

Title

Company

Date / Time

Date

Time

By pressing submit, you agree to the above listed terms.