Att B - Application.docx
DOCX document 28 KB Posted
- Solicitation number
- S-44300-00013845
- Issued by
- Oregon
About this file
This is an application form for lead-based paint remediation services managed by the Oregon Health Authority (OHA). The form solicits applications from qualified contractors and service providers to establish price agreements for lead risk assessment, lead abatement and hazard control, and clearance examination services across seven designated regions in Oregon: Cascade, Eastern, Metro/North Coast, Mid-Valley, Northeast, Southern, and South Valley & Coast regions. Applicants must identify their relevant discipline(s), geographic service areas, and any language capabilities beyond English that would support service delivery to diverse populations.
The application requires applicants to provide current licensing and certification information, including CCB numbers and lead-based paint activity certifications for all key personnel. Applicants must indicate their standard rates of pay for each discipline offered, specified as hourly rates, overtime rates, or monthly salary amounts. OHA will negotiate final pay rates with successful applicants selected for price agreements. The form requires applicant contact information, physical and mailing addresses, and authorized signatures with date and printed name and title of the signatory.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 2025.048 Legal Ad.pdf | ||
| Slide Deck for Informational Webinar 11-6-2023~1.pdf | ||
| 6127-0 final~1.pdf | ||
| Att C - Applicant Info Cert Cover Sheet~1.docx | DOCX document | |
| Att A - Sample Price Agreement.pdf | ||
| Link to Informational Webinar on YouTube 11-6-2023~1.docx | DOCX document | |
| Att E - Responsibility Inquiry.docx | DOCX document | |
| WEBINAR Transcript- Lead based paint_2023-11-06.docx | DOCX document | |
| Att D - COBID Outreach Plan.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Attachment B – Application Form Lead-Based Paint Remediation (tab to each text box to enter information)
Applicant Name/Name of Business:
Physical Location Address:
| City: |
| State: |
| Zip: |
| Telephone: |
| Cell Phone: |
| Email Address: |
| (optional) Fax #: |
Mailing Address (if different):
| City: |
| State: |
| Zip: |
Applicant is applying for the following Discipline(s)/Service type (check all that apply):
Lead Risk Assessment: |_| Lead Abatement and Hazard Control: |_| Clearance Examiner: |_|
Applicant is willing to serve the following regions (check all that apply):
|_| Cascade Region: Crook, Deschutes, Gilliam, Hood, Jefferson, Sherman, Wheeler, & Wasco Counties |_| Eastern Region: Baker, Grant, Harney, & Malheur Counties |_| Metro/North Coast Region: Clackamas, Clatsop, Columbia, Multnomah, Tillamook, & Washington Counties |_| Mid-Valley Region: Benton, Lincoln, Linn, Marion, Polk, & Yamhill Counties |_| Northeast Region: Morrow, Umatilla, Union, & Wallowa Counties |_| Southern Region: Curry, Jackson, Josephine, Klamath, & Lake Counties |_| South Valley & Coast Region: Coos, Douglas, & Lane Counties.
Languages: Indicate language(s) other than English that Applicant or Applicant’s employee speaks fluently or is qualified to speak and translate:
Arabic|_| Cantonese|_| Dari|_| French|_| Mandarin|_| Korean|_| Pashto|_| Russian|_| Somali|_| Spanish|_| Swahili|_| Vietnamese|_| Other (specify)
LICENSE AND CERTIFICATION(S):
Provide CCB # and License/Certification(s) held. If applicant is a business employing workers certified for lead-based paint activities, list each key person and their certifications.
OHA will negotiate pay rates with successful Applicants who are offered Price Agreements.
Indicate Applicant’s current standard rate of pay (or range of rates) for each Discipline:
Lead Risk Assessment: per hour overtime/hour, or monthly salary Lead Abatement and Hazard Control: per hour overtime/hour, or monthly salary Clearance Examiner: per hour overtime/hour, or monthly salary
Signature: Date:__________ .
Printed Name and Title : ________________________________________
RFA 6127 OB# S-44300-00013845
Application Form – Attachment B Page 2 of 2
File details come from the government source that posted it. Updated .