Contractor Application Homeowner Rehabilitation Assistance Program City of Lancaster Department of Housing Neighborhood Assistance Unit 120 North Duke Street Lancaster, PA 17602 717-291-4731Company Information Name of Firm: YOUK L005 C. WD Address: Kuby St Contact Person: Nar INBoc] ( Phone: /252.% 676 Fax E-mail address: yeuR house Kog7s 10 SS #:.QYS= Go 7SMederal Tax ID #:______ Business License #:. 44 0° 98/ List names of corporate officers and stockholders, if any. How many years has your company operated under the present business name? ors List the type of work (by construction trade) performed by your own employees, as well as the number of employees you presently employ in each trade: Trade # of Employees Koo Ling» LidinG. windows apes 2 Total: Certifications/Licenses List any professional certifications/licenses that you obtain. Provide copies of applicable insurance certificates to handle such work. Certifications/Licenses DateINoCataicon} List the names of fi the last year ) subcontractors with whom you have done the largest amount of business in Cary Nef. 2990 13/2. a) [ yo t Dicghs farlans , RIP: S{- 8252 Dan Diller, Mealy Don 35s (21 + Lavesbers Chores Deve. 299 2474 3. PST Pro Huns. Scot, G£2-97974 List the following information for the last five (5) residential remodeling jobs you completed: | Name/Address/Phone Contract Value/ Work Performed Completion Date 1 Ww Kies sk & 0a] oa fing: 2 1224 Senta burbeealy — § f000 bolas Sufth Cates zs 629 tb) Onuge f_te shngas, Ku Shur - ; & wnfeepitt. winds 4 g N bluzen SE Q Jloo * ser Ler, 5 2E A Lise L500 © Esper, - LoeFinancial Information limits of such credit: Name/Address ly have a line(s) of credit, including the Contact Person/Phone Credit Limit Caah AL Lavve Cook AC SA oofing Ae Le uly 1 Aw c Koy Are there any liens, claims ending legal action against your company? 220 If yes, explain, Has your company, or any principal owner, failed to complete a construction contract in the past five (5) years@_ASe-_ 1p , explain, Provide copies of your most recent financial stateme nt (balance sheet and statement of income and expenses), the purposes of qualifying to be fam, the unders nancial st included on th he bidder's list of the Hon owner Rel certifies the above information, in The undersigned further ag alters such circumstances, factor, or other ancaster concerning abilitation Assistance ing that p ees to notify the City The undersigned further person, firm, or corporation t any transactions ned hereby represents and ‘atement, to be true and correct. any change that materially plier, subcontr ided in the of Lancaster promptly y bank, material ‘mation requested authorizes ‘0 furnish any infor the City of with the undersigned, ote: If a corporation, this questionnaire must be signed by an il. If a partnership, e: authorized officer and imp ach partner must sign individually pressed with the corporate rmation given herein is correct and farther agrees: 1 inspector or if contract rel between the contractor and factory, the contr d from the approved lis. be provided. by US. Department of hat if the work is found to be unsatisfactory by thi the homeowner are found to be unsatist That required insurance and bond will That the contractor will abide -qual employment oppopuiy, ned Lau the Alotou (a lations ractor’s name may be removed Housing and Urban Development regulations pertaining to Date: LL S20 1S “ie Return Contract To: City of Lancaster; Neighborhood Assistance Unit 120 North Duke Street Lancaster, PA 17602 717-291-4731 fen a om a an fom he led Stes Evol Prtcon Agency ad om he ‘Pennsylvania Department of Health, Lead Hazard Conttol Program