Builder Application Form

Builder Application Form

Recitals

WHEREAS, Applicant Name: (the "Applicant") is engaged in the business of construction, renovation and related contracting services and represents that it possesses the experience, licenses, insurance and personnel necessary to perform building work in accordance with accepted industry standards and applicable law.

WHEREAS, Hiring Party Name: (the "Hiring Party") seeks to evaluate Applicant for potential engagement on the Project described below and requests information concerning Applicant's qualifications, financial capacity and proposed terms.

WHEREAS, the parties intend that completion of this Builder Application Form and acceptance by the Hiring Party may form the basis for a subsequent written agreement under terms described herein and subject to negotiation and final written contract.

Applicant Information

Individual Corporation LLC Partnership Other:

Licenses, Insurance and Certifications

Proof of insurance and certificate(s) of insurance are: attached pending and will be provided prior to mobilization.

Project Information

Scope of Work (Describe in detail)

Payment Terms

Proposed Contract Amount: $    Deposit Requested: $

Retainage:    Late Payment Fee:

Invoices submitted:

Term and Termination

Anticipated Start Date:    Anticipated Completion Date:

Either party may terminate any resulting agreement for cause upon written notice specifying the basis for termination. Notice period for convenience termination (if agreed): days.

Confidentiality

Applicant acknowledges that certain information provided by or on behalf of the Hiring Party may be confidential or proprietary. Applicant agrees to maintain confidentiality of all such information and to use it solely for the purposes of evaluating or performing the Project. Confidential information does not include information that (a) is or becomes publicly available other than by breach of this provision; (b) is lawfully obtained by Applicant from a third party without restriction; or (c) is independently developed by Applicant without use of confidential information.

Governing Law; Dispute Resolution

This Application, and any subsequent contract entered into as a result of this Application, shall be governed by and construed in accordance with the laws of the State of without regard to conflicts of law principles. The parties agree to seek resolution of disputes first through good faith negotiation; if unresolved, disputes shall be resolved in the courts located in the county where the Project is located, subject to applicable jurisdictional limits.

Representations, Certifications and Authorization

Applicant certifies that all information provided in this Builder Application Form is true, complete and correct to the best of Applicant's knowledge, that Applicant is authorized to execute this Application on behalf of the entity named, and that Applicant will promptly notify the Hiring Party of any material change to the information supplied herein. Applicant further represents that it is not currently subject to any unsatisfied judgments, material liens or unresolved licensing disciplinary actions that would materially impair its ability to perform the Project.

Applicant: certifies no unsatisfied judgments or material liens    discloses pending disputes:

References and Prior Projects

Attachments

The following documents are attached or will be provided upon request: copy of license certificate of insurance tax form / W-9

Entire Agreement

This Builder Application Form, together with any documents expressly incorporated herein by written reference, constitutes the entire understanding between Applicant and the Hiring Party with respect to the subject matter hereof. No prior or contemporaneous oral representations shall modify the written terms of this Application. Any subsequent agreement resulting from this Application shall be in writing and signed by authorized representatives of both parties to be binding.

Applicant Certification

By signing below, Applicant certifies that the information supplied in this Builder Application Form is true and correct, that the Applicant has the authority to submit this Application, and that, if retained, Applicant will enter into a written contract incorporating mutually agreed terms and conditions, including insurance, indemnity and warranty obligations customary for projects of similar scope.

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