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LEDC Contractor Application

Thank you for your interest in joining the Latino Economic Development Center (LEDC) Contractor Network!

LEDC has partnered with the Solar and Energy Loan Fund (SELF) to vet, approve, and pay contractors. By applying for the LEDC Contractor Network, you acknowledge that SELF has sole discretion to vet, approve, and pay you for work performed for LEDC clients.

Eligibility Requirements:

Current General Liability Insurance certificate
If available, Workers Compensation Insurance certificate
Signed W-9
Current State Construction Specialty License, or current local Construction License, if required

· As the authorized agent for this business, please be prepared to submit required credentials and to acknowledge the Terms and Conditions for the completion of the application.

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Company & Contact Information

Company Information

Company Name	Website
Street State	City Zip
Company mailing address is different than above	Mailing Street Mailing State County
Mailing City Mailing Zip

Contact Information

First Name

Last Name

Title

Add a second contact person

Phone (incl. ext)

Mobile

Email

Contact Information

First Name

Last Name

Title

Mobile

Phone (incl. ext)

Email

Service Areas

What counties in Virginia, Maryland, Washington, D.C are you readily available to service? Please do not select all.

First, select the states you are readily available to service

VirginiaMarylandWashington, D.C

Hold down the ctrl key to select more than one county

Please select the counties you are readily available to service?

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Please upload the following attachments.

Workers Compensation Insurance (If exempt, please also provide a copy)

Workman's Comp expiration date

General Liability Insurance

General Liability expiration date

State or Municipal Construction Trade License

State Specialty license expiration date

Signed W-9 or 1099

Disability Installations

Universal Design Certified Professional (UDCP)

Copy of Bond

Copies of any additional certifications (i.e. BPI, RESNET, NATE, ASHRAE, AEE, Disability installations, UDCP)
Only one document may be uploaded at a time. Click "Add another response" to upload an additional document.

Contractor's Acknowledgment of the

Terms and Conditions of Participation in Contractor/Vendor Program

By checking this box, I state that I have read and understood the TERMS AND CONDITIONS OF PARTICIPATION IN CONTRACTOR/VENDOR PROGRAM and I represent and warrant that (i) I am duly authorized to submit this Application on behalf of the Contractor; (ii) the information provided in the Application and any other related documents delivered to SELF, is true, accurate, and complete; (iii) I understand and accept the terms and conditions provided by SELF (including any updates thereto). I further understand and accept that the approval or rejection of the Application is at the sole discretion of SELF.

The Terms and Conditions of Participation in Contractor/Vendor Program are also available for review by clicking: Link

When clicking "Submit," you will have a final chance to review your application.