CITY OF PITTSBURGH From the Office of the Chief Application for ... - city pittsburgh pa 2026

1. Click ‘Get Form’ to open it in our editor.
2. Begin by entering the Applicant’s Name and L & I Agency Number in the designated fields. Ensure that all information is accurate.
3. Fill in the Mailing Address, including City, State, and Zip Code. This information is crucial for correspondence.
4. Provide your Phone and Fax numbers, along with your Contact/Position title and Email Address for further communication.
5. List the Employees Performing UCC Plan Review Services. For each employee, enter their Printed Name, Signature, and UCC Certification Number. If necessary, attach additional pages for more employees.
6. Complete the Errors and Omissions Insurance Information section by providing details about your insurance carrier, policy number, effective date, and expiration date.
7. Read and sign the Statement of Truth section to certify that all provided information is accurate. Don’t forget to have it notarized.

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