Application for Contractors | Cuyahoga County Home Repair Loan Program

Page 1

Thank you for your interest in working with CHN Housing Capital. We look forward to reviewing your application and engaging with you on the Cuyahoga County Home Repair Loan Program. Please take a few minutes to fill out the following application so we can get started working together!

Please note before you begin that you cannot submit a completed application without the following documentation:
Insurance certificate
Workers Comp certificate
Please have these documents ready when you start your application!

Page 2 | Business Info

Page 3 | General Criteria

# of years in business

In what year was your business established?

How many years experience do you have in direct construction/renovation?

Is your company in good standing with the State of Ohio?

List the primary municipalities in which you are registered to do business:

Who is your business' insurance company?

Please upload a copy of your general liability certificate.

Please upload a copy of your Bureau of Workers Compensation certificate.

Page 4 | Past Jobs & Certification

Please list the last three jobs completed in the past 12 months. Click "add another past job" below to add additional job history.

Past Jobs

Customer Name

Address Line 1

Address Line 2

City

State

Postal Code

Project Performed

Contract Amount

Name of Primary Contact

Primary Contact Phone

Certifications

I certify my business has the financial ability to carry jobs for a period of 30-45 days.

I certify that my business shall maintain a clean / safe worksite / provide excellent customer service and provide the owner with a full (1) one-year warranty on all work performed.

I certify that my business shall perform the work in a lead safe manor.

I certify that my business is a Drug Fee Workplace.

I certify that No Conflicts of Interest exist with my business. I further attest that no officer, employee or board members of CHN Housing Partners or its affiliates has any connection to, or any direct or indirect interest in my company.

Page 5 | Sign and Submit

Typing your name in the box below will serve as your electronic signature.

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application may result in my release.

Electronic Signature

Date