Pitt County Forms Center

2.  
   

   1717 W 5th Street Greenville, NC 27834  |  Telephone: (252) 902-3250

   Planning/Community Development Registered Contractor's Information Sheet

    

4. If you are interested in being added to the bid notification mailing list to receive current bid packages, please completed the contractor request form and attach the requested information.  If you have any questions, please contact Jason Bryant at 252-902-3259.

6. Date
   Date

8. General Information:

10. Contractor's Name:
12. Contractor's Mailing Address:
14. Contractor's Phone Number:
16. Contractor's Cell Phone Number:
18. Contractor's Email Address:
20. Number of Years in Construction/Rehabilitation Business:
22. Primary Employees:
24. Federal ID #:
26. NC Contractor's License #:
28. Lead Based Paint Certification:

30. Insurance Coverage:

31. Copy of CURRENT Insurance Policy:
33. Insurance Company:
35. On a separate line, list the name, address, and phone number of three completed job references through CDBG/HOME
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field