CBI@charlottenc.gov
600 East Trade St. Suite 300 Charlotte, NC 28202
704-336-4137
Section 1 of 5 - Participant Information
State
Section 2 of 5 - Company Information
CSI Code
Type of Entity
Date Business Established
Section 3 of 5 - Business Relationships
Do you currently have bonding?
In the past three (3) years, I have BID on City of Charlotte projects as a:
In the past three (3) years, I have been AWARDED on City of Charlotte projects as a:
Section 4 of 5 - Certification, Ethnicity, and Union Information
What is the status of your City of Charlotte, Charlotte Business Inclusion Certification?
Select all of the certifications that the business holds or for which the business is qualified to obtain:
Certified With (Mark all that Apply):
What is the ethnicity of the majority business owner?
Is your firm signatory to a union?
Section 5 of 5 - Authorization
I/WE AUTHORIZE AND CONSENT TO MERRIWETHER AND WILLIAMS INSURANCE SERVICES, INC. (MWIS), AS BOND ASSISTANCE PROGRAM ADMINISTRATORS, AND/OR SURETY/BANK OBTAINING INFORMATION FROM THIRD PARTIES, INCLUDING BUT NOT LIMITED TO, CREDITORS, BROKERS, SURETIES, INSURERS, BANKS, OR ANY INDIVIDUAL(S) OR INDIVIDUAL REPRESENTATIVE(S) OF ANY FIRM(S), ENTITY (IES) OR ORGANIZATION(S) RELATED TO THE EVALUATION OF MY/OUR QUALIFICATIONS. I/WE RECOGNIZE THAT TO ENSURE THE EFFECTIVENESS OF THE ENROLLMENT PROCESS, SUCH INDIVIDUALS MUST BE ABLE TO SPEAK FRANKLY AND OPENLY. ACCORDINGLY, I/WE HEREBY FULLY AND UNCONDITIONALLY RELEASE AND DISCHARGE THE PARTIES FROM ANY CLAIM OR LIABILITY RELATING TO INFORMATION PROVIDED IN CONNECTION WITH THE PROCESSING, INVESTIGATION AND EVALUATION OF OUR APPLICATION OR ENROLLMENT DOCUMENTATION.