 AT MOUNT LEBANON |
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1150 BOWER HILL ROAD PITTSBURGH, PA. 15243-0986 412-279-0100 |
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CONTRACTOR INFORMATION FORM This Form Must Be Completed And Submitted To The Office Prior To The Start Of Any Work. CONTRACTOR INFORMATION | |
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Company Name________________________________________ Phone Number_________________ Company Address____________________________________________________________________ Today's Date____________________ Date Work Is To Begin_________________________________ Unit #__________________________Resident's Name______________________________________ Description Of Work Being Done ________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Estimated Date Of Completion__________________________________________________________ Will Maintenance Need To Be Involved In This Project  Yes______ No______If Yes, Explain_______________________________________________________________________ ___________________________________________________________________________________ Insurance Information Company Name____________________________________ Policy Number______________________ Effective Date_____________________________________ Expiration Date_____________________ Copy Of Insurance Certificate Provided to Office  Yes__________ No___________Contact Information Foreman/Supervisor On-site Name__________________________ Phone Number_______________ I Have Read And Agree To The Follow The Contractor Rules & Regulations Yes_____ No______Signature____________________________________________ Date______________________ | |
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