NIAGARA FALLS UNIVERSAL CONTRACTOR APPLICATION

Transcription

1 NIAGARA FALLS UNIVERSAL CONTRACTOR APPLICATION NIAGARA FALLS HOUSING RENOVATION PROGRAM Center City Neighborhood Development Corp. Highland Community Revitalization Committee, Inc. Niagara Falls Neighborhood Services, Inc. Niagara Falls Community Development Dept. Four Agencies. One Application. One Goal: Renovate Homes in the City of Niagara Falls. This is the contractor application for the U.S. Department of Housing and Urban Development (HUD) and/or New York State-funded housing rehabilitation program. Qualified contractors contract with homeowners for housing rehabilitation work described in detailed specifications. A loan or grant of state or federal funds to the homeowner is used to pay all or a part of the rehabilitation work. The work is monitored by the agency providing the grant or loan. Housing rehabilitation contracts are awarded through a sealed bid process. Once qualified, contractors can bid on housing rehabilitation contracts for the programs administered by the City of Niagara Falls Community Development Department, Center City Neighborhood Development Corporation, Highland Community Revitalization Committee, Inc. and Niagara Falls Neighborhood Housing Services Corporation ( Agency or Agencies ). If you have any questions concerning this application, or concerning any of the information or documentation required for the application, please contact any of the following: City of Niagara Falls, Department of Community Development Dean M. Bailor, Jr. (716) , Fax , dean.bailorjr@niagarafallsny.gov Carnegie Building, 1022 Main Street P.O. Box 69, Niagara Falls, New York Niagara Falls Neighborhood Housing Services Corporation: Vergil Fiorentini, (716) , Fax th Street, Niagara Falls, New York Highland Community Revitalization Committee, Inc. Charletta Tyson, Executive Director, (716) , Fax Highland Avenue (Renaissance Center) Niagara Falls, New York Center City Neighborhood Development Corporation John Drake, Executive Director, (716) , Fax Main Street, Niagara Falls, New York Personal and Business Information We collect personal information from or about you such as your name, business name, address, mailing address and telephone number(s). We also collect business account information, financial statements and income information, insurance information, personal and business credit reports, credit history, credit scores and social security numbers. This information is reasonably required for ordinary business purposes. The information collected from and about you will be shared among the City of Niagara Falls, New York Community Development Department, Center City Neighborhood Development Corporation, Niagara Falls Neighborhood Services Corporation and Highland Community Revitalization Committee, Inc.

2 NIAGARA FALLS HOUSING RENOVATION PROGRAM Name of Company: Center City Neighborhood Development Corp. Highland Community Revitalization Committee, Inc. Niagara Falls Neighborhood Services, Inc. Niagara Falls Community Development Dept. Business Address: Owner s Name(s): Phone: Alternate Contact: No. of Years in Business: General Contractor Sole Proprietorship Sub-Contractor Partnership Corporation Is your business a: Minority Business Entrepreneur (MBE) Women Business Entrepreneur (WBE) Has the company ever failed to complete any awarded work? Yes No Has the company or any of its principal owners/officers/partners ever defaulted on a contract? Yes No Has the company or any of its principal/owners/partners currently filed for bankruptcy or voluntary dissolution in the past 7 years? Yes No Is company currently the subject of litigation? Yes No Trades your company performs in-house: Are there any liens against the company or its principal/owner/partner which might affect its ability to perform? Yes No General Carpentry Finish Carpentry Interior Painting Exterior Painting Drywall Plastering Resilient Flooring Ceramic Tile Roofing Gutters Window Replacement Heating Insulation Concrete Masonry Lead Interim Controls Lead Abatement Asbestos Abatement Bathroom & Kitchen Remodeling 2 P a g e

3 Plumbing License # Electrical License # Other - What dollar range of jobs do you prefer? 10K 15K 20K 25K+ Have you ever done work for any of these agencies? Yes No Business Bank: Niagara Falls Neighborhood Housing Services Inc. Center City Neighborhood Development Corporation. Highland Community Revitalization Committee. City of Niagara Falls Community Development Dept. Address: MATERIALS SUPPLIERS: Company Address $ Amount of Credit JOBS COMPLETED IN THE LAST 6 MONTHS: Customer Name Address Phone $ Job Size SUBCONTRACTORS USED WHTHIN THE LAST 6 MONTHS: Company Address Trade INSURANCE Agents Name Company Name Phone 3 P a g e

4 Have your insurance agent forward, an Insurance Certificate that: 1. Lists the Certificate Holder and Additional Insured 2. Provides a ten day notice of cancellation 3. Shows limits of liability and workers compensation coverage 4. Lists insured operations specifically as general contractor or for your specific trade(s) Please include the following with your application submission: IRS Form W-9 Cert. of General Liability Lead Paint Certification Documents (Firm and Worker) Workman s Compensation Certificate NYS Letter of Certification of M (Minority/Women) Business Entrepreneur Other Certifications: (Environmental Hazard Abatement, Etc.) PERMISSION TO OBTAIN CREDIT INFORMATION AND BACKGROUND CHECK I/We, the undersigned, understand that credit information will be obtained on my/our company as well as a background check will be performed on both my business and owner/s. By signing below, I/we agree that this information may be obtained as deemed necessary. Further consideration of my/our company may be refused without this permission or this application may be withdrawn if any discrepancies are discovered: Signed: SS# At later date Date: Signed: SS# At Later Date Date: 4 P a g e

5 INSURANCE REQUIREMENTS The low bidding contractor must show proof of having the following insurance coverage at the time the rehabilitation contract is awarded: 1. Comprehensive General Liability: Bodily Injury: $1,000,000 each occurrence, $2,000,000 aggregate Property Damage: $1,000,000 each occurrence, $2,000,000 aggregate NOTE: It is our requirement that the City of Niagara Falls be named as additional insured. The policy declaration page must read exactly as follows: CERTIFICATE HOLDER: Niagara Falls Neighborhood Housing Services Inc. Center City Neighborhood Development th Street Corporation Niagara Falls, NY Main St. Highland Community Revitalization Committee, Inc Highland Ave. (Renaissance Centre) Niagara Falls, NY Niagara Falls, NY ADDITIONAL INSURED: City of Niagara Falls, New York Department of Community Development 1022 Main Street, P.O. Box 69 Niagara Falls, NY Workmen's Compensation Insurance: Required for all of the general contractor's employees and the employees of his subcontractors engaged in work on the contract premises, in accordance with the local and State laws governing same. 5 P a g e

6 NIAGARA FALLS HOUSING RENOVATION PROGRAM Center City Neighborhood Development Corp. Highland Community Revitalization Committee, Inc. Niagara Falls Neighborhood Services, Inc. Niagara Falls Community Development Dept. REQUIRED DOCUMENTATION Please submit this application with the following documents. All agreements covered below whether written, oral, tacit or otherwise shall be reduced to writing and submitted as applicable. Additional comments, if applicable, may be attached to this affidavit. Contractor Requirements 1. Current financial statement, balance sheet, or latest IRS return. Yes / No / N/A 2. Certificate of Incorporation. 3. Partnership Agreements. 4. Joint Venture Agreements. 5. Business Certificate (DBA) 6. Certificate of insurance, showing statutory coverage ( worker's comp.). 7. Signed credit and performance authorization forms (6) with names and address of references included. (Forms are attached). 8. Authorization to obtain personal and business credit reports. Placement on this list does not exclude the contractor from meeting any additional requirements as may be set forth in each bid document 6 P a g e

7 NIAGARA FALLS HOUSING RENOVATION PROGRAM Center City Neighborhood Development Corp. Highland Community Revitalization Committee, Inc. Niagara Falls Neighborhood Services, Inc. Niagara Falls Community Development Dept. PERFORMANCE & CREDIT REFERENCES IMPORTANT PLEASE EXECUTE THE ATTACHED: - THREE (3) CREDIT REFERENCE FORMS - THREE (3) PERFORMANCE REFERENCE FORMS - AUTHORIZATION TO OBTAIN PERSONAL AND BUSINESS CREDIT REPORTS These Authorizations are Necessary in Order for Your References to Release Information (Please Sign Next to the "X" Only) 7 P a g e

8 PERFORMANCE REFERENCES Applicants Company Name: Mailing Address: Phone Number: TO WHOM IT MAY CONCERN: The above-referenced contractor wishes to establish eligibility for Niagara Falls housing renovation contract participation. Your name was given as a performance reference. Please assist in this effort by providing the following information: 1. Address where work was performed: 2. Type of Work Performed: 3. Date Work Began: 4. Date Completed: 5. Progress of Work: Expeditious Moderate Slow 6. Were you satisfied with the effort involved? Yes No 7. Performance Rated: Excellent Good Fair Poor. 8. May we contact you by Telephone? Yes No 9. Remarks: Performance Reference Signature Thank You for your time. Telephone Number Sincerely, Rehabilitation Specialist X Contractor's Signature Authorizing Information 8 P a g e

9 PERFORMANCE REFERENCES Applicants Company Name: Mailing Address: Phone Number: TO WHOM IT MAY CONCERN: The above-referenced contractor wishes to establish eligibility for Niagara Falls housing renovation contract participation. Your name was given as a performance reference. Please assist in this effort by providing the following information: 1. Address where work was performed: 2. Type of Work Performed: 3. Date Work Began: 4. Date Completed: 5. Progress of Work: Expeditious Moderate Slow 6. Were you satisfied with the effort involved? Yes No 7. Performance Rated: Excellent Good Fair Poor. 8. May we contact you by Telephone? Yes No 9. Remarks: Performance Reference Signature Thank You for your time. Sincerely, Telephone Number Rehabilitation Specialist X Contractor's Signature Authorizing Information 9 P a g e

10 PERFORMANCE REFERENCES Applicants Company Name: Mailing Address: Phone Number: TO WHOM IT MAY CONCERN: The above-referenced contractor wishes to establish eligibility for Niagara Falls housing renovation contract participation. Your name was given as a performance reference. Please assist in this effort by providing the following information: 1. Address where work was performed: 2. Type of Work Performed: 3. Date Work Began: 4. Date Completed: 5. Progress of Work: Expeditious Moderate Slow 6. Were you satisfied with the effort involved? Yes No 7. Performance Rated: Excellent Good Fair Poor. 8. May we contact you by Telephone? Yes No 9. Remarks: Performance Reference Signature Thank You for your time. Sincerely, Telephone Number Rehabilitation Specialist X Contractor's Signature Authorizing Information 10 P a g e

11 CREDIT REFERENCES Referenced Company: Mailing Address: Phone Number: Credit Reference: The above referenced contractor wishes to establish eligibility for the Niagara Falls Housing Renovation Program contract participation. Your name was given as a credit reference. Please assist in this effort by providing the following information: 1. Date account was established: 2. Current balance: 3. High credit allowed to charge: 4. How do you rate this account: Credit Reference Signature Date Phone Number X Contractor Signature Authorizing Information 11 P a g e

12 CREDIT REFERENCES Referenced Company: Mailing Address: Phone Number: Credit Reference: The above referenced contractor wishes to establish eligibility for the Niagara Falls Housing Renovation Program contract participation. Your name was given as a credit reference. Please assist in this effort by providing the following information: 1. Date account was established: 2. Current balance: 3. High credit allowed to charge: 4. How do you rate this account: Credit Reference Signature Date Phone Number X Contractor Signature Authorizing Information 12 P a g e

13 CREDIT REFERENCES Referenced Company: Mailing Address: Phone Number: Credit Reference: The above referenced contractor wishes to establish eligibility for the Niagara Falls Housing Renovation Program contract participation. Your name was given as a credit reference. Please assist in this effort by providing the following information: 1. Date account was established: 2. Current balance: 3. High credit allowed to charge: 4. How do you rate this account: Credit Reference Signature Date Phone Number X Contractor Signature Authorizing Information 13 P a g e

14 To: From: Housing Rehabilitation Agency Firm Applying for Contract Participation: Business Name: Address: Re: Authorization to obtain personal and business credit reports As a principal of the above referenced firm, I hereby submit an application to apply for certification as a preferred contractor. As a principal of the applying firm I understand that, as part of the certification process, a personal credit report on me will obtained. In addition, I understand that a business credit report will also be ordered for the referenced firm. By my signature below, I give authorization to obtain the personal and business credit reports as mentioned above. X Signature Print Name Title Date Witness 14 P a g e