This is an example page. It’s different from a blog post because it will stay in one place and will show up in your site navigation (in most themes). Most people start with an About page that introduces them to potential site visitors. It might say something like this:
Hi there! I’m a bike messenger by day, aspiring actor by night, and this is my website. I live in Los Angeles, have a great dog named Jack, and I like piña coladas. (And gettin’ caught in the rain.)
Section A - Business InformationPlease provide the legal name which appears on your business license, or under which your business will be operating as an independent contractor for GHP. Please further detail the contact information where you or your representative agent can be reached. Full Business NameType of Identity (e.g., individual, corporation, LLC, , etc.) *Business Mailing AddressLine 1Line 2City, State, ZipBusiness Street AddressLine 1Line 2City, State, ZipBusiness Contact InformationBusiness Phone NumberBusiness Fax NumberBusiness Email AddressSection B - Applicant InformationPlease provide the full legal name and address for the individual who is applying to contract with GHP, and who will serve as the point of contact for GHP projects. First NameLast NameDate of Birth (yyyy-mm-dd)Social Security NumberTitle or PositionResidence AddressLine 1Line 2City, State, ZipApplicant Contact InformationPhone NumberAlternate Phone NumberApplicant's Email AddressSection C - Contractor License InformationPlease provide a detailed account of the highest class of license to contract that you or your business entity hold to do business in the Commonwealth of Virginia or Gloucester County, and the name and contact information for the qualifying individual(s) listed on that license. If you or your organization hold multiple licenses to contract, please list any additional, relevant licenses under “SECTION F – ADDITIONAL INFORMATION” Classification of LicenseIssuing EntityLicense NumberDate Issued/RenewedQualifying IndividualFirst and Last NameDate of Birth (yyyy-mm-dd)Social Security NumberAddress Line 1Address Line 2City, State, ZipPhone NumberEmail AddressSection D - Insurance InformationPlease provide the required information on any general liability insurance policies that you or your organization currently hold for the purposes of conducting business in the Commonwealth of Virginia and/or Gloucester County. Name of InsurerType of Insurance/CoverageDate IssuedDate RenewedAmount of coverage (e.g., $1,000,000.00 in general liability) *Insurer's Business AddressLine 1Line 2City, State, ZipInsurance RepresentativeFirst and Last NamePhone NumberEmail AddressSection E - Required Application QuestionsAll questions in this section must be answered. Questions pertain to the applicant listed in Section B of this application form, and any and all employees of the business or applicant who are intended to work on the proposed contract for GHP. If “yes” in response to any question, the applicant must attach a separate sheet with a detailed explanation for each situation. NOTE: Answering “yes” to any of these questions DOES NOT automatically disqualify you from bidding on GHP projects. These questions are required by GHP to meet due diligence standards and uphold the professional responsibilities of our organization. To the best of your knowledge, is anyone listed on this application named in or responsible for any unsatisfied final judgements, liens, and/or claims against any bond or cash deposit pertaining to a construction project? If “yes” for this question, you are required to attach a statement identifying all judgements (pending or on record), liens, past due unpaid bills, claims, or suits and a detailed explanation of the situation. Include the names and addresses of the parties involved. If the obligation was or is being discharged in bankruptcy, attach a copy of the bankruptcy filing and a copy of the creditors list. * Any unsatisfied final judgementsHas anyone listed on this application ever been convicted of or entered a plea of guilty or nolo contendere to any felony or misdemeanor involving moral turpitude (I.E., lying, cheating, or stealing) in the united states? Note: Convictions that were later expunged from the records of the court or set aside must be disclosed. However, some convictions should not be disclosed, including: - Convictions that were adjudicated in juvenile court; - Charges that were dismissed as a result of successful completion of a deferred entry of judgement program (diversion program). If “yes” for this question, you are required to attach a statement disclosing the nature of the conviction and explain the acts or circumstances that resulted in the plea/conviction(s). Note: Failure to report a disclosable plea/conviction may be grounds for the denial of your application. * Felonies or misdemeanorsTo the best of your knowledge, has anyone on this application ever received a citation from the Virginia department of professional and occupational regulation or had a contractor license or other professional or vocational license or registration denied, suspended, revoked, or otherwise disciplined by the commonwealth of Virginia or elsewhere (I.E., other U.S. State, U.S. Territory, Agency of the Federal Government, etc.)? For the purposes of this question, “disciplined” is an administrative action that resulted in a restriction or penalty being placed on any license you have or have possessed, such as a revocation, suspension, probation, or reprimand. If “yes” for this question, you are required to attach a statement detailing the events leading to this action. * CitationDirect supervision and control over construction operations, includes any one or a combination of the following activities: supervising construction, managing construction activities by making technical and administrative decisions, checking jobs for proper workmanship, or direct supervision on construction job sites. Will you, as the applicant, perform one or more of these duties. NOTE: This question must be answered by the applicant and/or qualifying individual listed on the contractor’s license. * Supervision/ManagingSection F - Additional InformationWhere the space available for answers to questions in SECTION A through SECTION E is insufficient for a full, detailed response, please list additional information in this section. Additional InformationSection G - Certification of AccuracyThis section must be read by the applicant responsible for the contents of the GHP Independent Contractor Application. I certify, under the penalty of perjury under the laws of the Commonwealth of Virginia that all statements, answers, and representations made in this application, including all supplementary statements attached hereto, are true and correct, and that I have reviewed the entire contents of this application. I further recognize that, should any information in this application be incomplete or incorrect, GHP reserves the right to disqualify my business or organization from bidding on future contracts or projects. Name of Individual Certifying the ApplicationDate of Certification (yyyy-mm-dd) |
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