Adrian and Anika Culici - culicidreamhouse@yahoo.com 323.655.0804 - home phone ~ 208.275.2394 - fax 323.445.6294 - Anika's Mobile ~ 323.359.3326 - Adrian's Mobile Contractor Form: Getting To Know You Date: ___________, 2004 Company Name: __________________________________ Address: ____________________________________ ____________________________________ Contact Name: __________________________________ License# and exp. Date (do not leave blank): _____________________________________ Phone: ___________________________ Fax: _____________________________ Email address: ________________________ Web address: _________________________ Area of expertise (feel free to check more than one box): 0 General Contractor 0 Architect/Designer 0 Plumbing0 Landscaping 0 Painting 0 Tile/Ceramic0 Siding 0 Roofing 0 Flooring0 Masonry 0 Painting 0 Paving0 Fencing 0 Electrical 0 Other: How long have you been in business? ________________________________________ What certifications do you have? ___________________________________________ _______________________________________________________________________ Do you carry General Liability Insurance? 0 Yes 0 No 0 N/A If yes, please provide copy when submitting this form. Do you carry Worker’s Compensation Insurance? 0 YES 0 NO 0 N/A If no, can you provide us with a copy of your Construction Industry Certificate of Exemption from Worker’s Compensation? 0 YES 0 NO 0 N/A Who will be doing the actual work? 0 Me 0 My employees 0 Sub-contractors Who will be the foreman on this job? ________________________________________ How can we contact him/her? 0 Phone: __________________ 0 Fax: ____________________ 0 Email: __________________ How many hours per week should we expect the foreman to be onsite? ____________ How long should a job like this take? 0 Less than a week 0 1 – 3 weeks 0 4 – 8 weeks 0 8+ weeks How many other jobs will you be working on at the same time? 0 None 0 1 – 3 0 4 – 6 0 7+ Will you being paying material suppliers and/or sub-contractors: 0 Before completion of the job? 0 During the job? 0 After the job is completed? Will you pull all the required building permits? 0 YES 0 NO 0 N/A If yes, what is your rate for pulling building permits? $___________per____________ If no, can you explain why? ________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Will you provide us with a written lien waiver when job is completed? 0 YES 0 NO If yes, what is the time frame of receipt of lien waiver? 0 At job site, when work is completed 0 After inspection of completed work 0 You can expect the lien waiver in ______ days after work is completed. What kind of mess, noise or minor inconveniences should we (and our neighbors) expect? ______________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ How do you handle disposal of refuse? Will you notify us of heavy sanding days? 0 YES 0 NO 0 N/A Will make sure the site is swept cleaned at the end of the day? 0 YES 0 NO 0 N/A Will you make sure all debris is left in the refuse container at the end of the day? 0 YES 0 NO 0 N/A Do you guarantee your work? 0 YES 0 NO If yes, how long is the guarantee good?: Our guarantee is good for ______ year(s). Will you please provide us with at 3 references (can not be friends or relatives)? 0 YES 0 NO Reference 1 Name:_____________________________ Phone: ____________________________ Site Address: __________________________________ __________________________________ Work done: ______________________________________________________________________ Reference 2 Name:_____________________________ Phone: ____________________________ Site Address: __________________________________ __________________________________ Work done: ______________________________________________________________________ Reference 3 Name:_____________________________ Phone: ____________________________ Site Address: __________________________________ __________________________________ Work done: ______________________________________________________________________ If you have a website or online photo album, please provide link here: http://www._________________________________ (please feel free to also attach photos to this form) Additional comments: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Thank you for taking the time to complete this form. We will get in touch with you shortly.