Contractors

Basic Information

Business Type/Classifications

References

Please provide three local references.

Areas(s) of Specialty

Licenses held

Qualifications

• Does your company or any of its owners owe delinquent property taxes?
• Has your company ever defaulted on a contract?
• Has your company ever failed to complete work awarded to you?
• Is your company listed on the State of Ohio's debarment list or has it ever been?
• Is your company disqualified for work by a public organization or has it ever been?
• Has any kind of legal judgment been rendered against your company?
• Has your company ever filed for bankruptcy?

If your company would answer yes to any of these questions, please explain in full. Your answers to these questions will be researched and failure to answer any of these questions truthfully will disqualify your company from all Land Bank work.

Minimum Insurance Coverage/Worker’s Compensation

To pre-qualify for Land Bank work, your company must maintain and finish evidence of insurance and participation in Ohio’s worker compensation system.

The minimum insurance expectations are (unless otherwise noted by the Land Bank):

• General liability (limit of liability $1,000,000 each occurrence, $2,000,000 aggregate)
• Automobile liability (limit of liability $1,000,000); and
• Worker’s compensation (with statutory limit).

Your insurance carrier must provide a current Certificate of Insurance naming the Lucas County Land Reutilization Corporation as an additional insured with certificate holder status. Contractors must include current insurance information with this form and will be responsibile for providing updated insurance information after each annual renewal, a change in carrier, etc. Failure to provide this information now or in the future will disqualify the contractor from Land Bank work until corrected.

Required Documents

I certify that the information provided in this form is, to the best of my knowledge and belief, true, accurate, and complete. I have read the contractor terms and conditions available above, and I am authorized on behalf of the company to agree to such terms and conditions by my signature below.