City of Columbia
Community Development Block Grant (CDBG) Disaster Recovery Program
1225 Lady Street, Suite 102, Columbia, SC 29201
Contractor’s Application
To be considered for projects all Builders and Contractors must meet city, state and federal minimum requirements.
BUSINESS NAME: _______________________________________
Corporation
Limited Liability Corporation
Partnership
Sole Proprietor
BUSINESS ADDRESS: ____________________________________
____________________________________
BUSINESS TIN: ____________________________________
BUSINESS TELEPHONE: __________________________________
BUSINESS MOBILE: __________________________________
BUSINESS EMAIL ADDRESS: ______________________________
BUSINESS WEBSITE ADDRESS: ____________________________
Please indicate your company line of business:
New Construction
Remodeling
Lead Based Paint
Mold Remediation
Asbestos
Other:____________________________
Please List Certifications and/or Licenses
|Certifications |Licenses |
| | |
| | |
| | |
Business Name Search
The South Carolina Secretary of State’s records and the System for Award Management (SAM) database will be searched to determine if the company is registered, active and in good standing. In addition, bankruptcy records will be searched utilizing the last 4 digit of the business owner’s social security number.
1. In what year was your business started? If sole proprietor, indicated the year you started in the construction industry. __________________________
1. If applicable, provide any former name (s) your business has operated under and when? _____________________________________________________
2. Principle Owner (s) Name: _____________________________ Last 4 digit of Business Owner SS#: ______
_____________________________ Last 4 digit of Business Owner SS#: ______
Membership/Licensing
1. Is your company a member of the Home Builders Association or The Building Industry Association of Central South Carolina? YES or NO
If yes, name of association and member#:_____________________________________________________
2. List the jurisdiction and trade categories in which your organization is legally qualified to do business, and indicate the registration or license numbers, if applicable. __________________________________________
Experience & References
Submit the following information: name, address and a daytime phone number of three (3) clients who have benefitted from your companies home improvement services within the past twenty-four (24) months. All information requested must be completely provided and it will be fully verified.
These responses must indicate that their overall experience was favorable.
Provide contact information for (3) of your most recent completed projects.
|Owner/Project |Project Location |Contact Daytime Phone Number |
|MM/YY completed |Cost of Project | |
| | | |
| | | |
| | | |
Provide contact information for (3) projects currently under construction.
|Owner/Project |Property Location |Contact Daytime Phone Number |
|MM/YY work started |Cost of Project | |
| | | |
| | | |
| | | |
Provide references for at least (3) suppliers; (1) must be a major supplier
Accounts must have been open for a minimum of two years. At least one is required from a major supplier. Do not list subcontractors.
|Name |Account Number |Contact Phone #/ Email Address or Fax # |
| | | |
| | | |
| | | |
Attach copies of the following items:
1. Current City of Columbia Business License
2. Current Federal Lead Based Paint Certification requirements for persons performing Lead Based Paint Construction Activities and all other Certifications
3. LLR Residential Home Builder License OR LLR General Contractor License
4. Certificate of Insurance with a minimum General Liability of $300,000 (homeowner project only) or $2,000,000 (City owned projects and /or homeowner projects)
Acknowledgement and Agreement for Release of Information:
In order to evaluate the Residential Builder’s and General Contractor’s qualifications for placement on the City of Columbia’s Community Development Approval List, the undersigned hereby gives its/their consent to the City to contact business credit reporting agencies, named suppliers, project references, and to receive updates as may be required until such time this authorization shall be revoked, in writing. Should the 3rd party request verification to release information to the City of Columbia, we will provide a copy of this signature page for authorization.
I declare, certify, verify or state that, under penalty of perjury under the laws of the United States of America, the foregoing is true and correct.
Company Name: _________________________________________________________
Printed Name: _________________________________________________________ Date: _____________
Signature: __________________________________________ Title: ________________________________
Please return completed application to:
Attention: Crystal Hatten
Columbia CDBG Disaster Recovery Program
1225 Lady Street, Suite 102, Columbia, SC 29201
cghatten@
Phone: (803) 545-4465
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