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Housing Rehabilitation Program Contractor Questionnaire

2. The City of Brea currently provides home improvement loans through its federally funded Housing Rehabilitation Program and maintains a list of participating contractors.

   The City of Brea currently provides home improvement loans through its federally funded Housing Rehabilitation Program and maintains a list of participating contractors.

4. Contractors interested in bidding on the City's rehabilitation projects are asked to complete the Questionnaire below, and include the following documents: 1) W-9 form, 2) copy of State Contractor's license, 3) copy of City Business license, 4) copy of Certificate of Workers' Compensation Insurance, and 5) copy of Certificate of Liability Insurance (and all attachments).

   Contractors interested in bidding on the City's rehabilitation projects are asked to complete the Questionnaire below, and include the following documents: 1) W-9 form, 2) copy of State Contractor's license, 3) copy of City Business license, 4) copy of Certificate of Workers' Compensation Insurance, and 5) copy of Certificate of Liability Insurance (and all attachments).

6. Insurance must be equal to, or exceed the following requirements:

   Insurance must be equal to, or exceed the following requirements:

8. 

10. You may submit insurance and license information via fax to 714-671-4480, mail to City of Brea, Economic Development - Housing Rehab, 1 Civic Center Circle, Brea, CA 92821, or upload via this site.

    You may submit insurance and license information via fax to 714-671-4480, mail to City of Brea, Economic Development - Housing Rehab, 1 Civic Center Circle, Brea, CA 92821, or upload via this site.

14. Housing Rehabilitation Program - Contractor's Questionnaire

16. Name*

18. DBA*

20. Address*

22. City*

23. State*

24. Zip*

26. Telephone Number*

27. Fax Number

28. Email Address

30. City Business License Number

31. State License Number*

32. Type (attach copies)*

34. How long have you been in business?*

35. Number of Employees*

37. Credit References*

39. Material Suppliers*

41. Subcontractors*

43. List your three most recent remodeling/rehabilitation jobs by name, address, and phone number.*

45. If you have participated in other cities' housing rehabilitation programs, list the cities' names, addresses, phone numbers, and contact persons.*

47. Do you have experience working on mobile homes?*

    1. yes
    2. no

48. If yes, are you experienced with mobile home permit requirements?*

    1. yes
    2. no

50. Name of Person Filling out this Form*

51. Title of Person Filling out this Form*

53. Certification of Non-Discrimination by Contractor*

    I hereby certify that my contracting firm does not discriminate in its employment with regard to race, color, religion, sex, or national origin; that it is in compliance with all Federal, State, and local directives and executive orders regarding non-discrimination in employment; and that it agrees to demonstrate positively and aggressively the principle of equal opportunity in employment.

    1. I agree
55. The following documents are required with this questionnaire:

    1. W-9 Form
    2. State Contractor's License
    3. City Business License
    4. Certificate of Workers' Compensation
    5. Certificate of Liability Insurance

56. Upload Documents Here

    Please group all your documents into one file.

Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit Submit and Print

* indicates a required field