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Housing Rehabilitation Program Contractor Interest Form

2. Contractors interested in bidding on the City's rehabilitation projects mentioned on the previous page are asked to submit an interest form below. You will be contacted at a later date to provide additional information such as, but not limited to: references, W-9, copy of State Contractor's license, proof of Insurance, etc.
4. Insurance must be equal to, or exceed the following requirements:
6. 
10. Housing Rehabilitation Program - Contractor Interest Form
12. Company/Contractor Name*
14. Address*
16. City*
17. State*
18. Zip*
20. Telephone Number*
21. Email Address*
22. State License Number*
24. Name of Person Filling out this Form*
25. Title of Person Filling out this Form*
27. 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
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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit Submit and Print

* indicates a required field