Application for Approval of Contractor and Maintenance Providers - Simi Valley

Contractor Name: *

Name of Business: *

License No.: *

Address: *

Place of business, not a PO Box

Business Phone: *

Cell Phone: *

Fax: *

Email: *

Form of Business: *

Corporation
Business
Individual

Tax ID No. or Social Security No.: *

Please attach the following:

1. Contractor License
2. Certificate of liability insurance - $500,000 minimum
3. Certificate of Workers' Compensation Insurance
4. Certificate of Automobile Insurance - $500,000 minimum

Please indicate the top of work you provide: *

Other:

Areas you service: *

Client References – (Prefer Property Owners or Property Management Companies):

Name:

Address:

Their Business Phone:

Work Completed:

Name:

Address:

Their Business Phone:

Work Completed:

Name:

Address:

Their Business Phone:

Work Completed:

Name:

Address:

Their Business Phone:

Work Completed:

Are you related to anyone at Pacific-Realtors.net: *

Yes
No

Have you done work for Pacific-Realtors.net in the past: *

Yes
No

Terms & Conditions: *

I agree to the following:

Pacific-Realtors.net endeavors to do business with licensed and insured contractors who do high quality work. We are seeking long term relationships. The company currently manages nearly 50 properties in Los Angeles and Ventura Counties and we are continuing to expand. Any contractor offering a kickback to any of the company's Property Supervisors will be immediately removed from our list of approved contractors.

Please note that invoices submitted to the company for payment must be:

1. Billed to the client (property owner), care of the company.

For example:
Pacific-Realtors.net
5737 Kanan Road, Suite 630
Agoura Hills, CA 91301

Invoices billed to the company (as opposed to the client) are subject to being returned for correction. If returned, they will be processed with the next group of invoices for the subject property.

2. If applicable, an hourly billing rate and the number of hours billed.

3. Include a date and an invoice number.

4. Except for small parts that are kept in your inventory, original invoices for materials should be included.

In consideration of being approved as an "approved contractor," you hereby agree to the following:

1. To carry comprehensive liability insurance of at least $500,000 at all times that work is being done for the company and/or any of its clients, and

2. To indemnify, defend and hold Pacific-Realtors.net and/or any of its clients harmless from all damages, costs, expenses, attorney's fees, liabilities or claims which may arise by reason of and during the undersigned performance of his or her work.

Invoices are generally paid within 15 days of receipt assuming all work has been performed in a satisfactory manner. While not required, providing a self-addressed envelope will assure faster processing.

Submitted by: *

Date: *

Signature: *

Print Name: *