APPLICATION FOR CONTRACTOR APPROVAL
ALPOA
(Alpine Lake Property Owners Association, Inc.)
ECC
(Environmental Control Committee-9/05)
General Contractors who plan to
work within the boundaries of Alpine Lake must complete this application before
construction may begin. Subcontractors not working for a general contractor
must also complete this application. Copies of current licenses must be
attached (WV Contractor License, Certificate of Liability Insurance (WV) with
minimum limits of $300,000 for personal injury and property damage, and Worker’s
Compensation coverage). Suspension or cancellation of privileges to work in
Alpine
Name: ____________________________________
Address: ____________________________________
____________________________________
Phone: ____________________________________
Type of Company: _____Corporation _____Partnership _____ Individual
Name of Principals: ___________________________
___________________________
___________________________
___________________________
Type of Contractor: _____General _____Subcontractor _____Other
Type of WV License: __________________________ Exp. Date: _______________
The West Virginia Contractor
Licensing Act, Chapter 12, Article 11, revised 08/02, requires anyone engaged
in contracting for a job exceeding $1,000.00 must be a licensed West Virginia
Contractor. The ALPOA Environmental Control Committee does not interpret nor
answer any questions regarding the above-mentioned act. Any questions should be
referred to the West Virginia Licensing Board in
Insurance:
Liability Insurance Company: ______________________________________________
Amount of Coverage: ______________________ Exp. Date: ___________________
Bank Reference: ____________________ ________________________
____________________ ________________________
____________________ ________________________
Supplier Reference: ____________________ ________________________
____________________ ________________________
____________________ ________________________
Customer Reference: ____________________ ________________________
____________________ ________________________
____________________ ________________________
Affidavit: I (we), the principal(s) acknowledge that the information on the application is accurate, that we will promptly notify the ECC in writing if any information changes and that we understand and agree to the attached Requirements for Contractors.
Principal(s):
Signature __________________________________ Date: ________________
Signature __________________________________ Date: ________________
Signature __________________________________ Date: ________________
ECC Approval:
Signature __________________________________ Date: ________________
Signature __________________________________ Date: ________________
Signature __________________________________ Date: ________________
Contractor will attach: Copy of Licenses
Insurance Policy(s)