CLE Lead Safe | Application for Contractors

Page 1

Thank you for your interest in working with CHN Housing Partners. We look forward to reviewing your application and engaging with you in our lead safe initiative. 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
  • EPA RRP Renovator Certificate 
  • EPA RRP Lead Safe Firm Certificate

Please have these documents ready when you start your application!

LSCC Logo

Page 2 | Company Information 


Company

Company Address







Sole Proprietor

Address







Page 3 | Company Information, continued.



Primary Business Contact 




Page 4 | Company information, continued.

Should be in business for at least one year













Page 5 | Criteria

Please list the last three (3) jobs you and/or your company have preformed.

Past Job information










Page 6 | Certification 







Page 7 | Sign and Sumbit

Typing your name in the box below will serve as your electronic signature and as agreement to the following:

  • I certify that my answers contained in this online application are true and complete to the best of my knowledge. 
  • If this application is approved, I understand that any false or misleading information in my application may result in disqualification from the program.