Skip to Main Content
Loading
Loading
Search
Government
Services
Our Community
Business
How Do I…
Home
Form Center
Form Center
Search Forms:
Search Forms
Select a Category
All Categories
Customer Service
Fire Contact
Intranet
Neighborhood Services
Police Conference
Police Contact
Request Tracker
By
signing in or creating an account
, some fields will auto-populate with your information.
Grants Contractor Application
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Steps
1.
Company and Contact Information
This section is complete
This section is incomplete
2.
Owners and References
This section is complete
This section is incomplete
3.
Disclosures
This section is complete
This section is incomplete
4.
Contractor Supplement
This section is complete
This section is incomplete
Company and Contact Information
Company Name
*
Company Type
*
Corporation
Partnership
Privately Owned
Number of Years in Business
*
DUNS Number/CAGE Code
*
If you do not have a DUNS Number/CAGE Code, visit www.sams.gov to register.
Contact Person
*
Contact Person Position
*
Contact Person Phone Number
*
Street Address
*
City
*
State
*
Zip Code
*
Email
*
Phone
*
Fax
*
Construction Experience
*
Please indicate if experience is new construction, rehabilitation, or renovation.
Continue
Owners and References
Corporate Officers, Partners or Owners
Name
*
Title
*
Social Security Number
*
Name
Title
Social Security Number
Name
Title
Social Security Number
Name
Title
Social Security Number
Business References
Please list local banks and/or suppliers with whom your company has conducted business in the past 24 months.
Name
*
Address
*
Phone Number
*
Name
Address
Phone Number
Name
Address
Phone Number
Name
Address
Phone Number
Customer References
Please list customers with whom you have done business in the past 24 months.
Name
*
Address
*
Phone Number
*
Dollar Amount
*
Name
Address
Phone Number
Dollar Amount
Name
Address
Phone Number
Dollar Amount
Name
Address
Phone Number
Dollar Amount
All references will be verified
Continue
|
Go Back
Disclosures
Have you ever filed for bankruptcy?
Yes
No
The undersigned contractor certifies that all information given herein is correct and that the information may be verified from any source and further agrees:
1. That the State of Utah contractors class (indicated below) and bond therefore are current and agrees to maintain current status of all licenses and bonds as required by West Valley City.
*
License Class
2. That the contractor will perform the work in accordance with the description of work, general specifications and applicable City, State, or County codes and zoning regulations and be subject to final inspection by a West Valley City Building Inspector.
3. That if the work performed by the contractor is found to be unsatisfactory or if the contract relations between the contractor, homeowner, or other parties is found to be unsatisfactory, West Valley City may remove their name from the list of contractors without notice.
4. Copies of the contractor's licensed Section 3 Business Certification must be uploaded as attachments with this application.
License
*
Section 3 Business Certification
*
Download a Section 3 Business Certification Form
Section 3 Business Certification
5. Copies of the W9 and proof of Workman's Compensation & Insurance must be submitted to be included as a Preferred Contractor but do not need to be attached. Documentation may be submitted separately and must be submitted before beginning work.
W9
Download an IRS W9 Form
IRS W9 Form
Workman's Compensation & Insurance
Continue
|
Go Back
Contractor Supplement
State License Number
*
State License Type
*
Number of Years as a Contractor
*
Federal Tax ID Number
*
Please check the appropriate items:
*
This information will be used for statistical purposes.
Male
Female
Handicapped
Disabled
Veteran
Caucasian
Hispanic
African American
Pacific Islander
American Indian
Asian
Other
General Instructions
1) The contractor must meet all State of Utah licensing requirements. This also requires that proof of adequate liability insurance and workman's compensation coverage be provided. 2) The Contractor must obtain all required building permits prior to starting work. 3) All workmanship must conform to the Program's guidelines, building codes and be of acceptable quality.
Digital Signature & Acknowledgement
Name
*
Completion of the Name, title and date fields constitute your digital signature.
Title
*
Date
*
Leave This Blank:
Receive an email copy of this form.
Email address
This field is not part of the form submission.
Submit
|
Go Back
* indicates a required field
Public Notices
Meeting Agendas & Minutes
Code and Ordinances
Departments
Administration
City Attorney's Office
Community & Economic Development
Building Inspections
Economic Development
Planning & Zoning
Community Preservation
Animal Services
Code Enforcement
Grants
Housing
Cultural Celebration Center
Department Year-End Reports
Finance
Fire Department
Human Resources
Justice Court
Parks & Recreation
Police Department
Public Relations
Public Works
City Facilities
City Budget
WVC Utility Billing
How do I...?
Apply for a Job
Browse Events Calendar
Contact a City Department
File a Claim Against West Valley City
Pay My Bill
Read City Council Agendas & Minutes
Read Municipal Code
Receive E-mail Notifications
Request a Record
Run for Office
Submit a Service Request
Report Code Violations
Report Graffiti
Jobs
Contact Us
Pay Your Bill
Jobs
Service Request
Police
Fire
Government Websites by
CivicPlus®
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow