Contractor Qualification Form

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Required Documents

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Your submission has been received. If you'd like to start the qualification process right away, you may continue to the next page.
After you complete the form, you will be required to submit copies of the documents below.

All Programs

  • Resume
  • Financial Statement
  • W-9
  • EPA Lead Paint Hazard Certificate
  • EPA Lead Paint Renovator
  • Insurance certificates: Workers' Compensation & NYS Disability Benefits Insurance as required by New York State law
HIO Additional Required Documentation
  • Insurance Certificates: 
    • Comprehensive General Liability at least $500,000 for bodily injury (each occurrence) and $500,000 for property damage (each occurrence). However, contractors may opt to obtain $1,000,000 single limit liability coverage instead 
    • Umbrella Insurance of at least $1,000,000
    • Automobile Liability 
  • Nassau/Suffolk License with photo
If qualified as contractor, CDLI will need to be named as additional insured and shall receive 30 days' notice of any change, cancellation or non-renewal of any and all policies.  
ADU Plus One Program Additional Required Documentation
  • Insurance Certificate: Comprehensive General Liability at least $500,000
  • Suffolk / Town of Southampton / Town of Shelter Island License with photo
  • References
If qualified as a contractor, CDLI, the State of New York, and The Housing Trust Fund Corporation will need to be named as additional insured and shall receive 30 days’ notice of any change, cancellation or non-renewal of any and all policies.





List the name, address, telephone number, and position of each principal of the company. "Principal" means each officer and director of the bidder and each shareholder, partner and co-venturer who either controls or owns, directly or indirectly, a ten percent or greater interest in the bidder or who will actively participate in the performance by the bidder of the proposed contract.



Veteran Owned Business



List all other businesses in which the majority owners, partners, officers, and shareholders have held affiliation or interest in the past (5) years
Name of Business Address Work/Service Performed Contact Person Phone Number


Please list all types of home improvement projects that your firm is capable of performing such as: roofing, siding, heating systems, accessibility measures, insulation, windows, etc.