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DOEE PROFESSIONAL LEAD-BASED PAINT CERTIFICATION APPLICATION
_________________________________________________________________________________________________________________________________

Application ID#

a.15348^

Record ID#

15348

PayPal Invoice Amount

$300

Applicant Name

Bradbern Construction Co., Inc.

Portal member ?

Role ID# and Role Name

13/Submitter

Step 1 (Create an Account Request)

# of Docs in this account

0 Business Docs

Save and Create Acct

Save and Create Account Request

Main

TYPE OF APPLICATION

Application Type *

Record Status

For Reciprocity Applicants Only - Current State Certification/ License

For Renewal Applicants Only - Expiring or Expired D.C. Certification No.

For Renewal Applicants Only - Expiring or Expired D.C. Certification Expiration Date

For Reciprocity Applicants Only - State of Current License

For Reciprocity Applicants Only - Current State Certification/License No.

For Reciprocity Applicants Only - Expiration Date of Current State Certification

For Renewal Applicants Only: Upload Copy of Previous or Current D.C. Certification ID Card

Badgetype *

You will need the following:

Please continue to process your application.
Upon clicking save your badge number and invoice amount will be populated.
Your new Badge Number is DC25-5348

If you would like to process your payment for your application prior
to receiving an invoice Please pay the amount of $300 here*this will open in another browser tab/window

PERSONAL INFORMATION

COMPLETE ONLY FOR INDIVIDUAL DISCIPLINE CERTIFICATIONS

First Name *

Last Name

Address

City

State

Zip Code

Phone

The email address is used to contact professionals with compliance and enforcement updates. DOEE is not responsible for incorrect email addresses.

Email Address (Used for communication with the applicant)

Photo Identification Card

Date of Birth (mm/dd/yy)

Sex

Height (feet)

(inches)

Applicant's Training Information:

Training Certificate Expiration Date (DC)

tbd

Third Party Event Passed (Inspectors, Risk Assessors, or Supervisors only)

Upload Third-Party Event Results

Your Position

Description of Duties

Optional - Supervisor's Name (If self-employed, enter "self-employed")

Optional - Supervisor's Phone Number

Optional - Supervisor's Email Address

Upload a passport style photo in jpeg - For renewal this is not required.

Blank for BE.jpg
Delete this file

WORK DISCIPLINE REQUIREMENTS

Work discipline requirements are located here
Review the work discipline requirements, complete the applicable fields and attach required evidence of education and/or experience before saving this application.

Please upload a reference to provide evidence of relevant work experience (inspectors, risk assessors, supervisors, or project designers only). This must include name, company, phone number, email address, applicant position, dates of experience, detailed description of specific type of relevant work performed by the applicant, reference's signature, and date.

Relevant Work Experience

Education

Check box for highest level of education (risk assessors and project designers only)

High School

Institution

High School's Name

High School's Address

High School's Phone Number

ext.

Institution's Name

Institution's Address

Institution's Phone Number

ext.

From

Degree

Please upload your education credentials (official academic transcripts or diploma) as recognized documentation to meet this requirement (risk assessors and project designers only).

Education Credentials

COMPANY INFORMATION

COMPLETE FOR INDIVIDUAL DISCIPLINE AND BUSINESS ENTITY CERTIFICATIONS

Company Name - For Individual Discipline Certification Applicants - Optional

Address

City

State

Zip Code2

Telephone Number

Fax Number

Business Email

* Upload Evidence of Personal or Company Liability Insurance including environmental liability in an amount sufficient to cover the lead-based paint activity.

(business entity applicants only)
- If you plan to conduct lead abatement activities, attach a copy of a Certificate of Liability Insurance, proving the applicant s current policy coverage for at least one million dollars ($1,000,000) for individual environmental,
lead claims or pollution insurance, which the applicant shall maintain throughout the entire period that the lead abatement permit is in effect.
- If you plan to conduct abatement or demolition activities, attach a copy of a Certificate of Liability Insurance, proving the applicant s current policy coverage for at least two hundred fifty thousand dollars ($250,000) for individual
environmental or lead claims, which the applicant shall maintain throughout the entire period that the renovation permit is in effect.

Evidence of Personal or Company Liability Insurance

Bradben Construction Co.,-COI exp 5-9-26.pdf
Delete this file

* The District of Columbia is not an agreement jurisdiction with the Nuclear Regulatory Commission (NRC). Contact NRC before conducting work in the District of Columbia.*

Check if you plan on using X-Ray Fluorescence (XRF)

Evidence of radioactive material license - Stopped requiring this license on July 26, 2013.

Affidavits-Clean Hands Form-Enforcement

FOR INDIVIDUAL DISCIPLINE APPLICANTS ONLY

The information that I have provided in this �DOEE Application for Lead-Based Paint Certification Form� is true, accurate, and complete to the best of my knowledge.

I understand that my application is subject to verification, and I agree to provide any additional documentation required to review that application.

I also understand that outside sources may be contacted for purposes of verifying the information contained in this application, and I hereby give permission for the disclosure
of any information that may be needed to determine the validity of the information that I have provided and/or to determine eligibility for the certification sought.

I understand that failure to provide full disclosure of any requested information that may be needed to determine the validity of this application or eligibility for certification may result
in the rejection of this application.

I also understand that completion of this application does not guarantee lead-based paint certification in the District of Columbia.

Further, I understand that if the Department finds that I have made a false statement or misrepresentation material to the issuance, modification, or renewal of a certification,
the Department may, after notice and opportunity for hearing, suspend, revoke, modify, or refuse to issue, renew, or restore the certification. The Department may also seek to
impose administrative, civil, or criminal penalties under D.C. Official Code � 8-231.01 et seq.

Finally, I understand that under D.C. Official Code � 22-2405, any person convicted of making false statements shall be fined not more than $1,000, or imprisoned for not
more than 180 days, or both. A person commits the offense of making false statements if that person willfully makes a false statement that is in fact material, in writing directly or
indirectly to any instrumentality of the District of Columbia Government, under circumstances in which the statement could reasonably be expected to be relied upon as true.

Check if you agree

Individual Applicants - Review of Certification Requirements *

For Business Entity Applicants

The District Government shall not issue or reissue any license or permit if the applicant owes it more than $100 in outstanding debt. A false statement on this certification requires that the District Department of Energy and Environment (DOEE), proceed immediately to revoke the certification, accreditation and/or permit or renewal for which you are now applying and fine you $1,000. This certification form is required to be completed and submitted with any application for a certification, accreditation and/or permit or renewal by the Clean Hands Before Receiving a License or Permit Act of 1996, effective May 11, 1996 (DC Law 11-118, DC Official Code Sec. 47-2861 et seq.) as amended, effective October 21, 2000 (DC Law 13-183, sec. 2(b), DC Code sec. 47-2861 et. seq.). As of the date, does not owe more than more than one hundred dollars ($100) in outstanding debt to the District of Columbia Government as a result of: 1. Fines, penalties, or interest assessed pursuant to the Lead�Hazard Prevention and Elimination Act of 2008, effective March 31, 2009 as amended (DC Law 17-381; D.C. Official Code � 8-231.01 et seq (2013 Supp.)); or 2. Fines, penalties, or interest assessed pursuant to the Litter Control Administration Action of 1985, effective March 25, 1986, (DC Law 6-100; DC Code Sec. 8-801 (et seq.) (2001 ed.); or 3. Fines, penalties, or interest assessed pursuant to the Illegal Dumping Enforcement Act of 1994, effective May 20, 1994 (DC Law 10-117; DC Code Sec. 8-901 (et seq.) (2001 ed.); or 4. Fines, penalties, or interest assessed pursuant to the Department of Consumer and Regulatory Affair (DCRA) Civil Infraction Act of 1985, effective October 5, 1985 (DC Law 6-42; DC Code Sec. 2-1801.01 (et. seq.) (2001 ed.); or 5. Past Due Taxes owed to the Office of Tax and Revenue pursuant to Title 47 of the DC Code; or 6. Past due District of Columbia Water and Sewer Authority service fees pursuant to Title 34 Chapter 22 and 24 of the DC Code (2001 ed.); or 7. Fines, penalties or interest assessed pursuant to Traffic Adjudication Act, Title 50, Chapter 23, of the DC Code (2001 ed.) I understand that a signed and dated Clean Hands Self-Certification Form is required as documentation to accompany my application for a certification, accreditation and/or permit or renewal. I understand that by completing and submitting this form, I am not guaranteed that my certification, accreditation and/or permit or renewal will be approved. I understand that the District Department of Energy and Environment (DOEE) and/or the Department of Consumer and Regulatory Affairs (DCRA) may conduct an investigation to ascertain the veracity of the information contained in this Clean Hands Self-Certification Form. I understand that if I knowingly provide false information on this Clean Hands Self-Certification Form, DOEE will proceed immediately to revoke each certification, accreditation and/or permit or renewal for which I am applying, and to fine me one thousand dollars ($1,000).

Check if you agree

Business Entity Applicants - Review of Certification Requirements *

GO TO MYTAX.DC.GOV TO OBTAIN A CLEAN HANDS CERTIFICATE FROM THE OFFICE OF TAX AND REVENUE. This Clean Hands Certificate is required to be completed and submitted with any application for a certification, accreditation and/or permit or renewal by the Clean Hands Before Receiving a License or Permit Act of 1996, effective May 11, 1996 (DC Law 11-118, DC Official Code Sec. 47-2861 et seq.) as amended, effective October 21, 2000 (DC Law 13-183, sec. 2(b), DC Code sec. 47-2861 et. seq.). Tutorials on how to request a Clean Hands Certificate are located at https://otr.cfo.dc.gov/node/1198920. For individuals with no identification submit the request using the email address cleanhands.cert@dc.gov

Clean Hands Certificate *

For Individual Applicants: Has any federal, state or local jurisdiction ever revoked, suspended, modified, or proposed to revoke or suspend, or modified any permit, license, certification, or
approval you have held or currently hold, or has any penalty action or fine been assessed against you for failure to comply with the laws and regulations pertaining to lead-based paint?

For Business Entity Applicants: Has any federal, state or local jurisdiction ever revoked, suspended, modified, or proposed to revoke, suspend, or modify any permit, license, certification or approval your company has held or currently holds, or has any penalty or fine been assessed against your company or business for failure to comply with the laws and regulations governing lead-based paint activities?

Yes/No

If you answered Yes to the above question, you must provide a detailed statement to fully explain the circumstances.

Statement

*Consent

FOR INDIVIDUAL APPLICANTS:
...*DOES NOT APPLY TO DISTRICT AGENCY EMPLOYEES

CAN DOEE LIST YOUR NAME, MAILING ADDRESS, CITY, STATE, ZIP CODE, CONTACT NUMBER, AND EMAIL ADDRESS ON OUR WEBSITE AS A CERTIFIED PROFESSIONAL WORKING IN D.C.?
...IF YES, INDICATE BELOW WHICH MAILING ADDRESS AND CONTACT INFORMATION IF DIFFERENT FROM ABOVE

FOR BUSINESS ENTITIES:

CAN DOEE LIST YOUR BUSINESS NAME, CITY, STATE, CERTIFICATION NUMBER, EXPIRATION DATE, CERTIFICATION TYPE WEBSITE AND EMAIL ADDRESS ON OUR WEBSITE AS CERTIFIED AND WORKING IN D.C.? IF YES, INDICATE YOUR RESPONSE BELOW.

Yes/No

Write Here What You Consent To Post On Our Website

Please provide any additional information about your application, like special handling requests.

Save or Submit

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Admin

ID Card#

ID CARD NO:

DC25-5348

Abandoned Apps

Registered

PayPal Invoice Amount

$300

View develop tab

*****Developer

FOR INDIVIDUAL APPLICANTS Has any federal, state or local jurisdiction ever revoked, suspended, modified, or proposed to revoke or suspend, or modified any permit, license, certification, or approval you have held or currently hold, or has any penalty action or fine been assessed against you for failure to comply with the laws and regulations pertaining to lead-based paint? FOR BUSINESS ENTITY APPLICANTS Has any federal, state or local jurisdiction ever revoked, suspended, modified, or proposed to revoke, suspend, or modify any permit, license, certification or approval your company has held or currently holds, or has any penalty or fine been assessed against your company or business for failure to comply with the laws and regulations governing lead-based paint activities?

Save (new form)

SAVE

Make a payment

https://dcwebforms.dc.gov/pay/doee1

*****Admin-1

*Application Status2

Approved

Date Created

11-10-2025 12:19 PM

Save (Manager)

Save (Manager)

cb99

Email-

eric@bradbern.com

Mark as new

Approval Status

Approved*

page - Date Created

user-0

PAY NOW

not selected

Search URL

Back to Search

View*

View Application

Edit control

Save (new form)

SAVE

*save

save

*****Admin-2

App Token

bzqdrm_t6n_0_bdk7zbddb6ucn9bhpdkbhdecszwz

Role ID#

role-submitter

View Application

role-staff

View Application

Email-X

Email-

eric@bradbern.com

page - Email-0

danisha@iwant2helpyou.com

Email test-1

SAVE (add new)-test

*****Admin-3

# of Applicant Training Information

# of Evidence of Personal or Company Liability Insurance

# of Third-Party Event Results

# of Docs (app originated)

xBusiness Name

Businesses: Business ID#

*****Documents

***Documents

Add Document

	Doc ID#	Document	Notes	Document Purpose

No Document records found

*****Help Tickets

***Tickets

Add Help Ticket

	Ticket#	Ticket Category	Help request description	Target Location

No Ticket records found

*****Accreditation applications

*****Logs

Add Log

Unable to display report. You do not have sufficient permission.

# of X-Ray Fluorescence (XRF)

# of Photos

# of Relative Work Experience

# of Education Credentials

# of DLCP Basic Business License or Exemption

# of Lead-Based Paint Credentials

# of Evidence of radioactive material license

# of Clean Hands Certificates

# of Federal, State or local Jurisdiction

Business - Company Name

Business - Company Street Address

Business - Company City

Business - Company State

Business - Company Zip Code

Business - URL

Business - Company Phone

Business - Company Fax

Business - Company Website

Business - Company Email

Business - *Biz Email

Business - *webpage

Business - Record ID#

Business - POC

Business - POC Email3

Business - Company Info

Individual - User Name (account)

Individual - First Name

Individual - Last Name

Individual - MI

Individual - Street Address

Individual - City

Individual - State

Individual - Zip Code

Individual - Phone

Individual - Email Address

Individual - Date of Birth (mm/dd/yy)

Individual - Sex

Individual - Height (feet)

Individual - Height (inches)

Individual - High School

Individual - Institution

Individual - High School's Address

Individual - High School's Phone Number

Individual - Hign School Name

Individual - Institution's Phone Number

Individual Name

Individual - Institution's Address

Individual - From

Individual - To

Individual - Education Credential Title

Individual - Education Credential Type

Individual - Institution's Name

Individual - User Name (account)2

Business Individual Manager

Individuals - Individual ID#

# of Upload Previous/Current D.C. Certification ID Card

# of Current State Certification/ License

Individual - Record ID#

Business - Record ID#2

Individual - # of Evidence of radioactive material license Docs

Individual - # of Upload Third-Party Exam Results Docs

Individual - # of Applicant's Training Information Docs

Individual - # of DC Clean Hands Certificate Docs

Individual - # of Current State Certification / License Docs

Individual - # of Education Credentials Docs

Individual - # of DLCP Basic Business License Docs

Individual - # of Evidence of Personal or Company Liability Insurance Docs

Individual - # of Federal, State or Local Jurisdiction explanation Docs

Individual - # of Lead-Based Paint Credentials Docs

Individual - # of Passport-Style Photo Docs

Individual - # of Photo ID Card Docs

Individual - # of Previous/Current D.C. Certification ID Card Docs

Individual - # of Relevant Work Experience Docs

Individual - # of X-Ray Fluorescence (XRF) Docs

Business - # of Evidence of DLCP Basic Business License or Exemption Docs

Business - # of Evidence of Personal or Company Liability Insurance Docs

Business - # of Clean Hands Certificate Docs

Business - # of Federal, State or Local Jurisdiction explanation Docs

Business - # of Lead-Based Paint Credentials Docs.

Business - # of DLCP Business License Exemption Docs.2

Individual - # of Docs (I)

Individual - # of Third-Party Exam Results Docs

Individual - # of Project Designer Initial or Refresher Docs

Individual - # of BS/BA in Eng. etc. Docs

Individual - # of (4) years of experience in building... Docs

Individual - # of (1) year of experience in buiding... Docs

Individual - # of New DC Clean Hands Certificate Docs

Individual - # of DC Law Exam Results Docs

Individual - # of Initial Dust Sampling Technician Course Docs

Individual - # of DDOE-accredited refresher dust docs

Individual - # of Initial Lead-Based Paint Inspector Docs

Individual - # of Explanation of the Circumstances Docs

Individual - # of Lead-Based Paint Inspector Refresher Docs

Individual - Highest level of education

Individual - # of DLCP Basic Business License Exemption Docs

Individual - # of D10 Docs

Individual - # of D11 Docs

Individual - # of D12 Docs

Individual - # of D13 Docs

Individual - # of D14 Docs

Individual - # of D15 Docs

Individual - # of D16 Docs

Individual - # of D17 Docs

Individual - # of D18 Docs

Individual - # of D19 Docs

Individual - # of D20 Docs

Individual - # of D21 Docs

Individual - # of D22 Docs

Individual - # of D23 Docs

Individual - # of D24 Docs

Individual - # of Bachelor's degree Docs

Individual - # of Associate�s degree Docs

Individual - # of high school diploma Docs

Individual - # of D25 Docs

Individual - # of D26 Docs

Individual - # of D27 Docs

Individual - # of D28 Docs

Individual - # of D29 Docs

Individual - # of (1) year of experience in building...-1 Docs

Individual - # of (2) years of experience in a related field...Docs

Individual - # of (3) years of experience in a related field...Docs

Individual - # of Risk Assessor Substitution Certification Proof Docs

Business - # of Docs (B)

Business - # of DLCP Business License Exemption Docs

Business - # of Explanation of the Circumstances Docs

Business - # of D10 Docs

Business - # of D11 Docs

Business - # of D12 Docs

Business - # of D13 Docs

Business - # of X-Ray Fluorescence (XRF) Docs

Business - # of DLCP Basic Business License Docs

Business - # of D14 Docs

Business - # of D15 Docs

Business - # of D16 Docs

Business - # of D17 Docs

Business - # of D18 Docs

Business - # of D19 Docs

Business - # of D20 Docs

Business - # of D21 Docs

Business - # of D22 Docs

Business - # of New DC Clean Hands Certificate Docs

page - Submitted Status

Individual - Business - Record ID#

Note:

Business - Record ID#3

*****AI&EI Records

Available Business Contacts

Individual - # of Audits

Business - # of Audits

Business - # of Enforcements

Individual - # of Enforcements

Individual - Account Email

page - search test

# of Docs

Individual - Last Name2

Individual - Email Address2

Business - Company Email2

Select account holder

Account ID#

b.1598

Account - (inches)

Account Holder

Portal Account Type

Business

Account - Address

204 Monroe Street

Account - City

Rockville

Account - Date of Birth (mm/dd/yy)

12-04-1989

Account - Degree

Account - Education Credential Type

Account - Email Address

eric@bradbern.com

Account - First Name

Eric

Account - Height (feet)

Account - High School

Account - MI

Account - # of A-docs-1

Account - # of A-docs-2

Account - # of A-docs-3

Account - # of A-docs-4

Account - # of A-docs-5

Account - # of A-docs-6

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Account - # of A-docs-9

Account - # of A-docs-10

Account - # of A-docs-11

Account - # of A-docs-12

Account - # of A-docs-13

Account - # of A-docs-14

Account - # of A-docs-15

Account - # of A-docs-16

Account - # of A-docs-17

Account - # of A-docs-18

Account - # of A-docs-19

Account - # of A-docs-20

Account - # of A-docs-21

Account - # of A-docs-22

Account - # of A-docs-23

Account - # of A-docs-24

Account - # of A-docs-25

Account - # of A-docs-26

Account - # of A-docs-27

Account - # of A-docs-28

Account - # of A-docs-29

Account - # of A-docs-30

Account - # of A-docs-31

Account - # of A-docs-32

Account - # of A-docs-33

Account - # of A-docs-34

Account - # of A-docs-35

Account - # of A-docs-36

Account - # of A-docs-37

Account - # of A-docs-38

Account - # of A-docs-39

Account - # of A-docs-40

Account - # of A-docs-41

Account - # of A-docs-42

Account - # of A-docs-43

Account - # of A-docs-44

Account - # of A-docs-45

Account - # of A-docs-46

Account - # of A-docs-47

Account - # of A-docs-48

Account - # of A-docs-49

Account - # of A-docs-50

Account - # of A-docs-51

Account - # of A-docs-52

Account - Record ID#

1598

Account Holder Email

Account Applicant Name

Bradbern Construction Co., Inc.

Related Account2 - Select account holder

Account - Select Employee Manager

Account - Last Name

Bernstein

Account - Sex

Male

Account - State

Account - Zip Code

20850

Account - Phone

(301) 807-4672

Account - High School's Name

Account - High School's Address

Account - High School's Phone Number

Account - Institution's Address

Account - Institution's Name

Account - Institution's Phone Number

Account - Institution

Account - To

Account - From

Account - Highest Level of Education

n/a

Account Holder Email2

QB Account Holder Full Name

Eric Bradbern

Account - Related Business

Account - Business - Company City

Account - Business - Company Email

Account - Business - Company Fax

Account - Business - Business Name

Account - Business - Company Phone

Account - Business - Company State

Account - Business - Company Street Address

Account - Business - Company Website

Account - Business - Company Zip Code

Account - Business - POC

Account - Business - POC Email

pending Business POC Email input

xAccount - Business - POC Phone

Account - Business ID#

Portal Member Account Status

Active

page - Notification List-1

Derek Anderson

Portal Account Applicant Email

eric@bradbern.com

Portal Account Applicant Name

Bradbern Construction Co., Inc.

Business - POC Email

Account - Record ID#2

1598

Account - # of A-Docs

Business - Company Phone*

Account - Business - Company Phone*

xAffiliated Portal account #

Account Type

Business

page - Search Term

Manual Override Show Recd

Account - Business - POC Email.

pending Business POC Email input

Account - Business - POC Phone.

pending Business POC Phone input

Portal Account Manager EMAIL

eric@bradbern.com

test-d

Account - Goto Business

https://octo.quickbase.com/db/bebnufh5u?a=dbpage&pagename=call-and-redirect.html&url=https%3A%2F%2Focto.quickbase.com%2Fdb%2Fbr3ey5bpm%3Fa%3DAPI_EditRecord%26apptoken%3Dbzqdrm_t6n_0_bdk7zbddb6ucn9bhpdkbhdecszwz%26rid%3D0%26_fid_215%3D1598%26_fid_282%3Db.1598&redirect=https%3A%2F%2Focto.quickbase.com%2Fdb%2Fbr3ey5bpm%3Fa%3Ddr%26rid%3D0%26dfid%3D11%26ifv%3D1

# of Document records+

Account - Business Name

Bradbern Construction Co., Inc.

Account - Date Created

11-10-2025 11:54 AM

Account - Business Address

204 Monroe Street, Suite 201

Account - Business City

Rockville

Account - Business State

Account - Business Zip Code

20850

Account - Business Contact Email

Brad@bradbern.com

Account - Business Contact Phone

3012510756

Account - Business Fax

Account - Business Website

Account - Business Contact Email2

Brad@bradbern.com

Account Manager (email)

Brad@Bradbern.com

Account Manager (last name)

Bernstein

Account Manager (first name)

Bradley

xAccount Manager (phone)

Account - EAT

xAccount - Date Created2

11-10-2025 11:54 AM

View Account Link

Display....

zAccount Manager (QB user)

Eric Bradbern

Portal Account Manager Email.

eric@bradbern.com

Portal Account Manager Name.

Eric Bradbern

Account - Timer-1

Account - add/review Education Info (optional)

master account #.

1597

Account - Business Profile ID#

Account - Related Business2

Account Manager (phone)

Account - Business - 2nd POC

Business - BN1

Business - Busines_Email

Business_City

Business_Fax

Business_Phone

Business_State

Business_Street Address

Business_Website

Business_Zip Code

Business_POC (name)

Related Account2 - Record ID#

Print ID Card (PDF)

Print ID Card (PDF-2)

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