Contractor Application.pdf

Single Family Home Repair Program

Contractor Application

City of Detroit Housing & Revitalization Department

Community Development Division

Coleman A. Young Municipal Center 2 Woodward Avenue, Suite 908

Detroit, Michigan 48226

313.224.6380

Julie Schneider, Director

All applications and attachments must be emailed to HRDHomerepair@detroitmi.gov

July 18, 2019 1

Housing and Revitalization Department Community Development Division

Single Family Home Repair Contractor Application

Business Name:

Business Address:

Business Phone: Home Phone:

Email:

Type of Entity (Sole Proprietor, Partnership or Corporation:

Year Business Established:

Federal Employer ID Number:

Michigan Builders License Number:

Gross Business Income (Sales) Last Year:

Number of Employees, including working Owner(s):

Do you have prior experience working with Federal housing programs? Yes No If yes, what programs? ___________________________________________________________

Is this a minority or woman owned business? If yes, check which applies. WBE MBE (Must be a for-profit business, 51% owned, operated, capitalized and controlled by a member(s) of a presumed group and/or woman and are U.S. citizens).

Please check types of work performed by you and/or your employees. (Do not check work performed by Sub-Contractors.)

Carpentry Excavation HVAC Plumbing Demolition Energy Lead Remediation Roofing Electrical General Contracting Masonry/Concrete Other

Owner Information (Provide for all owners, attach a separate sheet, if needed):

Name: Phone:

Street Address: City/State/Zip:

Name: Phone:

Street Address: City/State/Zip:

Name: Phone:

Street Address: City/State/Zip:

July 18, 2019 2

Customer References (List four current jobs underway or most recently completed):

Type of Work: Contract Amount:

Name: Address:

Phone: Email:

Type of Work: Contract Amount:

Name: Address:

Phone: Email:

Type of Work: Contract Amount:

Name: Address:

Phone: Email:

Supplier/Subcontractor References (List four high dollar volume suppliers or subcontractors):

Business Name: Business Address:

Business Phone: Contact Name:

Contact Phone: $ Volume Last Year:

Business Name: Business Address:

Business Phone: Contact Name:

Contact Phone: $ Volume Last Year:

Business Name: Business Address:

Business Phone: Contact Name:

Contact Phone: $ Volume Last Year:

Business Name: Business Address:

Business Phone: Contact Name:

Contact Phone: $ Volume Last Year:

Revised April 2019 3

Please answer the following questions regarding your business:

Yes No Is the applicant presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from covered transactions by any Federal department or agency?

Has the applicant within a three year period preceding tis application been convicted of or had a civil judgment rendered against them for the commission of fraud or criminal offense?

Is the applicant presently indicted for or otherwise criminally or civilly charged by a government entity (Federal, State or local?)

Has the applicant within a three year period preceding this application had one or more public transactions (Federal, State or local) terminated for cause or default?

Does the State of Michigan or any local agency have a tax lien against your firm?

Has the applicant/licensee ever been organized or done business under another corporate or company name, in the capacity of a residential builder?

Has the applicant ever had a registered complaint, investigation, subpoena, suspension of license, cease and desist order, or criminal prosecution by the Residential Builder’s and Maintenance and Alteration Contractor’s Board of the State of Michigan?

If any of the above questions are answered yes, please provide an explanation on an attached sheet.

The undersigned authorized representative certifies that all information herein is correct and that information may be verified from any source and further agrees:

1. That the State of Michigan Residential Builder License is current, and that the undersigned contractor agrees to maintain current status of all licenses as required by the Housing & Revitalization Department;

2. That the undersigned authorizes the Housing and Revitalization Department to verify and further investigate any of the information provided;

3. That all information provided is true, correct and complete.

Applicant/Business

Name and Title of Authorized Representative

Signature of Authorized Representative Date

Revised April 2019 4

Please attach the following documents:

State of Michigan Residential Builder License

City of Detroit, Buildings, Safety Engineering and Environmental Department (BSEED) Registration

Last 2 Years Tax Returns and/or Business Profit fit Loss Statement

Certificate of Insurance (Fidelity/Dishonesty Requirement) o Worker’s Compensation not less than $500,000 o Comprehensive General Liability Insurance $1,000,000 o Automobile Liability Insurance $1,000,000 o Must evidence City of Detroit as an additional certificate holder o Must include 30 day written notice of cancelation notice to HRD

Environmental and Pollution Liability (Errors and Omissions) o Minimal limits:

o $1,000,000 Each Occurrence o $2,000,000 Annual Aggregate o Contractor must have their policy: (1) be applicable to the work being performed, including completed operations equal to or exceeding statute of repose; (2) not have exclusions or limitations related to Transportation (upset overturn, spills during loading or unloading, Hazardous Materials Handling, and Non Owned disposal site liability; and (3) endorsed to add “the State of Michigan, its departments, division, agencies, offices, commissions, officers, employees, and agents” as additional insured.

Coverage must not have exclusions or limitations related to lead (Pb) associated work.

Conflict of Interest

Renovation, Repair, Painting Program Certification (EPA)

Human Rights Affidavit

Property Tax/ Accounts Receivable Clearance

Resolution of Corporate Authority (if applicable)

Statement of Political Contributions

Income Tax Clearance Request (ITC)

MDHHS Lead Abatement Firm Certification

MDHHS Lead Abatement Supervisor Certification(s)

MDHHS Lead Abatement Worker Certification(s)

Section 3 Owner/Developer and General Contractor (Forms can be found at:

https://detroitmi.gov/departments/housing-and-revitalization-department/hud-programs-and-information/section-3-program)

Revised April 2019 5