Laserfiche WebLink
Exhibit A: Lead Hazard Reduction Program Contractor Application <br />Is applicant registered, or willing to register, in the System for Award Management (SAM) and the <br />Federal Awardee Performance and Integrity Information System (FAPIIS)? <br />M'Y'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 grantor both? <br />❑ IHCDA Grant Only ❑ OLHCHH Grant Only 2 5oth 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: C9 Yes ❑ No <br />I understand that if placed on the Registry, 1 will receive notice of opportunities to bid on Lead Hazard <br />Reduction Program work. And I understand that work will be awarded to the lowest, responsive and <br />responsible bid: 2'S'es ❑ 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. Bes ❑ No <br />0j"Is <br />Name <br />