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TYPE OF APPLICATION....100% Application Type info...
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COMPANY INFORMATION....33% Company/Employment Info ...
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BUSINESS ENTITY....83% Buisness Entity Info ...
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AFFIDAVITS AND SHARING INFO CONSENT....100% Affidavids Info ...
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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).

* FOR BUSINESS ENTITIES:

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

Not Authorized

0

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SAVE ACTIONS....Overall Completion: 82%
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FEES PAYMENT NOTICE
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APPLICATION COMPLETION is 63% .....
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**TYPE OF APPLICATION ----->
~ New/Initial Applicant -->100%
~ Renewal: n/a
~ Reciprocity Request: n/a

N/A%

CERTIFICATION REQUIREMENTS --->
%

Employer INFORMATION REQUIRED --->100%

Position INFORMATION REQUIRED --->0%

OTHER INFORMATION REQUIRED --->0%

~ Business Entity --->%

~ Business Entity --->100%

~ Consent --->0%