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2. PURPOSE:

   The purpose of this application form is for the Town to collect information about contractors interested in providing services and support to residential property owners that are seeking flood resilience and drainage/stormwater improvements on their property.  The Town will make a list of contractors available on its website and include the information identified as "Public Information." This form is voluntary. The Town does not provide any kind of qualification, certification, or verification of this information and listing of a contractor in the directory does not represent an endorsement of the company or its services. For questions, email stormwater@carrboronc.gov or call 919-913-2999.

4. A. CONTACT INFORMATION

   Enter contact information for the business and/or person seeking listing under the contractor directory. This will be Public Information.

6. Business Name*
8. Business Website*
9. Business Address*
11. Principal
13. Contact Person*
15. Contact Email*
16. Contact Telephone*
18. Date Business Established
19. DUNS
21. Geography Served*
23. B. CERTIFICATIONS

    Check boxes where applicable. This will be Public Information.

25. Professional Credentials

    1. Professional Engineer
    2. Registered Landscape Architect
    3. Other (describe)
26. Other Professional Credentials
28. NC State Cooperative Extension Certifications

    1. Stream Bank Repair Certification
    2. Residential Rain Garden Professional
    3. SCM Inspection and Maintenance Professional
29. Other Certifications (see below)

    1. Historically Underutilized Business
31. If Historically Underutilized Business, are you listed on the NC Department of Administration vendor list?
    -- Select One --YesNo
32. If yes, enter Company Name listed in the directory

    Directory can be found at: https://www.ips.state.nc.us/vendor/searchvendor.aspx?t=h

34. C. DESCRIPTION OF BUSINESS*

    Use the textbox above to describe your business and the general services you offer. This will be Public Information.

36. D. TRADES/SERVICES PROVIDED

    Check the boxes next to the trade or service that your organization provides, either by performing directly or by sub-contractors or partners. Check as many boxes as necessary. This will be Public Information.

38. Flood Resilience for Buildings*

    1. Building Elevation
    2. Dry or Wet Floodproofing
    3. Foundation Tuckpointing, Sealing, Membranes and Crawlspaces
    4. Gutter and Downspout Cleaning, Repair and Replacement
    5. Mechanical System Elevation
    6. Sump Pumps and Drain Tiles
    7. None of the above
39. Flood Resilience for Yards*

    1. Erosion Control
    2. French Drains and Dry Wells
    3. General Landscaping
    4. Riparian and Stream Enhancement, Restoration and Stabilization
    5. Soil Improvements
    6. None of the above
40. Green Residential Stormwater Infrastructure*

    1. Cisterns and Rain Barrels
    2. Impervious Surface Removal or Replacement, Permeable Pavement
    3. Rain Gardens, Backyard Wetlands or Ponds
    4. Regenerative Stormwater Conveyances and Swales
    5. Rooftop or Impervious Surface Disconnection
    6. Stormwater Control Measure Maintenance and Inspection
    7. None of the above
41. Other Services*

    1. Pool Water Hauling
    2. Sewage Spill Clean Up
    3. None of the above
43. Services self-performed or performed by subs/partners?*
    -- Select One --Self-performedPerformed by subs/partnersBoth
45. E. ADDITIONAL DOCUMENTS

    Upload the following relevant documents as applicable. A list of what documents were submitted WILL be made public, but uploaded documents will NOT be Public Information.

47. Required Documents
49. W-9 Form*
50. Certificate of insurance*
52. Optional Documents

    Such as:

    • General Contractor license
    • NC State Stream Bank Repair Certification
    • NC State Residential Rain Garden Professional Certification
    • NC State SCM Inspection and Maintenance Certification
    • Proof of Bonding
    • Trade License(s) and/or Professional Registration(s)
    • Business License(s): municipal, county, or state
54. General Contractor License
55. Stream Bank Repair Cert.
56. Rain Garden Prof. Cert.
57. SCM M&I Cert.
59. Proof of Bonding
60. Trade licenses
61. Business licenses
63. F. CERTIFICATION*

    I certify that the information and documentation included in this application are true and accurate to the best of my knowledge. I understand that listing in the contractor directory does not represent endorsement by the Town of Carrboro. I authorize the Town to publicly publish the information identified as “Public Information.”

    1. I certify the above statement
    2. I do NOT certify the above statement
65. Name of Applicant*
67. Title of Applicant*
69. Company*
71. Date of Submission*
Leave This Blank:


73. 1. Receive an email copy of this form.
74. Email address

    This field is not part of the form submission.

75. Submit

* indicates a required field