Garrison Home Service LLC — A SiegHaus Partner Company

Contractor Network
Application for Network Participation

Complete all sections in full. Incomplete applications are not processed. Submission does not guarantee network admission.

Required Attachments

(1) Current certificate of insurance naming Garrison Home Service LLC as certificate holder · (2) Copy of PA HIC registration · (3) Copy of applicable trade license

Email attachments to asieg@sieghausrepairs.com following submission.

Section A

Business Information

Business Legal Name *

DBA / Trade Name

Business Address

City / State / ZIP

Primary Phone

Business Email *

Website

Years in Business

Entity Type

Owner / Principal Name *

Owner Direct Phone

Owner Email

Employees / Crew Size

Primary Service Area

How did you hear about SiegHaus?

Section B

Licensing & Insurance

PA HIC Registration #

HIC Expiration Date

Trade License Type

Trade License Number

Trade License Expiration

GL Insurance Carrier

GL Policy Number

GL Per-Occurrence Limit

GL Policy Expiration

Workers' Comp Carrier

WC Policy Number

WC Policy Expiration

Section C

Trade Scope

Check all trades you are licensed and insured to perform as primary contractor.

Other Trades (describe)

Do you use subcontractors for any portion of your work?

Yes

Section D

References

Provide two residential client references in Cumberland County or surrounding area. References will be contacted by phone.

Reference 1

Client Name

Phone Number

Project Type / Year

Location (City / Town)

Reference 2

Client Name

Phone Number

Project Type / Year

Location (City / Town)

Section E

Background Disclosures

Answer all questions accurately. A yes answer does not automatically disqualify. Failure to disclose known issues may result in permanent removal from the network.

Has your PA HIC registration or any professional trade license ever been suspended, revoked, or subject to disciplinary action?

Yes

Has your business been the subject of a PA Attorney General consumer protection complaint in the past five years?

Yes

Have you been a party to litigation arising from a residential construction or repair project in the past three years?

Yes

Does your business currently have any unsatisfied judgments or active liens against it?

Yes

Has any prior business you owned or operated under a different name been subject to any of the above?

Yes

Section F

Applicant Certification

By signing below, I certify that all information in this application is true, complete, and accurate to the best of my knowledge. I understand that false or omitted information is grounds for immediate and permanent removal from the Garrison Home Service Contractor Network. I acknowledge that submission of this application does not guarantee network admission, and that admission, if granted, is at the sole discretion of Garrison Home Service LLC and may be withdrawn at any time.

Signature *

Sign here with mouse or finger

Date

Printed Name and Title

Business Legal Name

Email required attachments to asieg@sieghausrepairs.com following submission. Fields marked * are required.