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Exhibit A: Lead Hazard Reduction Program Contractor Application <br />7. Is applicant registered, or willing to register, in the System for Award Management (SAM) and the <br />7Yeral Awardee Performance and Integrity Information System (FAPIIS)? <br />es, currently registered <br />❑ Not currently registered, but willing to complete (the City can provide a registration guide) <br />❑ Not registered, and will not complete <br />8. Do you want to be placed on the registry for one rant or both? <br />ElIHCDA Grant Only ElOLHCHH Grant Only Both Grants <br />9. Please list any residential property owned solely or co -owned by you within the City of South Bend: <br />I certify that the answers provided are true and accurate to the best of my knowledge: Yes ❑ No <br />I understand that if placed on the Registry, I will receive notice of opportunities to bid on Lead Hazard <br />Reduction Progra m <br />work. And I understand that work will be awarded to the lowest, responsive and <br />responsible bid:Yes ❑ No <br />I have read and agree to the minimum specifications and program conditions for participation in the Lead <br />Hazard Reduction Program's Registry of Pre -Qualified Contractors. Z,Yes ❑ No <br />Signature <br />Ran <br />1 <br />Name (Printed) <br />031 0112,1 <br />Date <br />