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Hi-Desert Water District
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Interested Contractor Application
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Steps
1.
Company Information
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This section is incomplete
2.
License Verification
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This section is incomplete
3.
Bonding and Insurance
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4.
Project Experience
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5.
Sign and Submit
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Company Information
Company Name:
Company Address:
Company Phone:
Company Website:
Contact Name:
Contact Phone:
Contact Email:
Number of Employees:
Company DIR #:
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License Verification
License Verification
List all California construction license numbers, classifications and expiration dates of the California contractor licenses held by you and your firm. (Contractors must have a current contractors license, which is subject to verification).
How many years has your firm been in business in California as a contractor under the contractor's present business name and license number?
Have you or your firm's contractor's license been revoked and/or received an infraction from the California Contractor State License Board within the last five years?
Yes
No
If "yes," please provide a brief explanation for the penalty and/or violation.
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Bonding and Insurance
Bonding and Insurance:
The contractor shall carry and maintain insurance, at the contractor's sole cost and expense, including Workers' Compensation Insurance, as required by the Labor Code or proof the contractor is legally self-insured or exempt.
Name of Bonding Company/Surety:
Bonding Company Address:
Name of Agent:
Agent Phone:
Bonding Amount:
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Project Experience
How many satisfactorily completed projects has your firm completed?
Septic tank projects
-- Select One --
0-5
6-10
11-20
21-50
51+
Sewer pipeline projects
-- Select One --
0-5
6-10
11-20
21-50
51+
How many private property connections could your firm complete in a day, including septic tank abandonment?
-- Select One --
0-2
3-5
6-10
11-15
16-20
21+
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Sign and Submit
I certify that to the best of my knowledge, the information provided above is true and accurate. I am properly licensed and qualified to perform the work related to installing a sewer lateral on private property. I will also comply with all city, state and federal requirements.
Authorized Representative
Title
Signature
Date
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