Application for Contractors | Energy & Utility Services

Page 1

Thank you for your interest in working with CHN Housing Partners. We look forward to reviewing your application and engaging with you on the Energy Services 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 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 45-60 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