Business Fax:
Please Print or Type.
Firm Name:
Business Address:
Business Phone:
Contact Email Address:
Names and addresses of all owners, partners and, if a corporation, the names of major stockholders
and/or officers:
Years in Business:
Federal I.D. #:
List construction experience of each of the principals:
Indicate the firm’s experience with other publicly funded rehabilitation programs (include location and
number of houses rehabilitated):
Credit References (i.e., local banks, material suppliers):
County Administrative Offices
West Complex
22215 Dupont Blvd. | PO Box 589
Georgetown, DE 19947
Phone: (302) 855-7777
Fax: (302) 854-5397
Community Development & Housing
Rev. 08/2018
Names, addresses, and phone numbers of at least three recent customers (non-related) who have had
home improvement work done by your firm:
Is the firm:
Minority-Owned Woman-Owned Veteran-Owned
None of the above
*Note: (1) Copies of the firm’s licensing and insurance should accompany this completed
Contractor Data Sheet when returned to the Department of Community Development &
Housing. (2) Houses bid out by the Department shall not exceed a maximum of $25,000 per
house. (3) Houses are bid out to General Contractors, who then, if applicable, seek
subcontractors to assist with the project’s completion. (4) The County will not provide up-front
funding for the rehabilitation projects. Funds will only be released to Contractor upon
completion of work. (5) Lead certificates are required, unless otherwise noted. (6) The
department reserves the right to reject any bids, as well as limit the number of projects
awarded to bidders based on the scope of work that needs to be completed by the contractors
within the 60-day contract period.
THE UNDERSIGNED CONTRACTOR(S) CERTIFIES that all information given herein is
substantially correct and further agrees:
1. That Sussex County’s and/or State Business License are current, and the undersigned
contractor agrees to maintain in a current status all licenses and insurances as required by its local
2. That the work will be performed in accordance with the Sussex County Building Code
requirement standards, subject to a clear final inspection by the project inspector.
3. That if work performed by the contractor is found to be unsatisfactory by the
administering agency, or if contract relations between the contractor, homeowner or other
parties are found to be unsatisfactory, that the administering agency may remove the contractor’s
name from the approved list.
4. That adequate proof of insurance will be provided, with minimum of $100,000 contractor general
5. That he or she will abide by U.S. Department of Housing and Urban Development
regulations pertaining to equal employment opportunity.
6. That work will be done in conformance with all applicable codes and zoning regulations.
Printed: Date:
Signed: Signed:
Representative of Sussex County