Contractor Application Form - Rehabilitation Programs

This form is to be completed by each contractor who intends to bid for work that is assisted through the LIHP Housing Rehabilitation Program.  Satisfactory completion of this form enables you as a contractor to be placed on the list of Available Contractors, that LIHP staff will distribute to eligible homeowners who are ready to invite bidders.  Copies of current Nassau or Suffolk County Home Improvement Licenses and proof of insurance must be attached to this form.  Please note that for the rehabilitation work in the towns of Southampton, East Hampton, Shelter Island and Mastic Beach Village a locally issued contractor's license is required.

Please indicate the years of experience you have in any of the areas below:

I authorize the LIHP program administrators to verify the above information and I certify that the above information is true and complete: