Glazier Nation Labor Request Form

LABOR REQUEST FORM
COMPANY INFORMATION
Company Name*
Glass Contractor
Company Representative*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PROJECT INFO
Project Name*
Project Name
Project Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your project must be managed by your own Superintendent. Will your project have one?*

YESNO
Project Start Date*

MonthDayYear
First date labor requested on jobsite.
Anticipated Completion Date

MonthDayYear
This can be approx
Total Labor Requested*
Project Brief Description*
PROJECT REQUIREMENTS
These questions (insurance)apply to jobs that are Davis Bacon- ROCIP, CCIP and/or OCIP. Glazier Nation supplies a COI to all companies that it works under
Davis Bacon*

YESNO
Insurance Program Req'd*

YESNO
Type of Ins Program Req'd

OCIPCCIPRocipOther
Prevailing Wage Rate $ Fringe Benefit $
(This is to be provided if Davis-Bacon or any other Certified Payroll)
Enrolled Workers Comp*

YESNO
OSHA Required*

YESNO
OSHA

1030Other
Prevailing Wage Documents

Browse Files
Upload supporting documents for Prevailing Wage Cancelof

Onboarding Process*

	YES	NO
Background Check
Drug Test

Type of Labor*

FabricatorSill Pan/ Receptor InstallFrame ErectorGlass SetterPerimeter CaulkerWet Glaze CaulkerCertified WelderCertified Dogmen/ WelderCertified Boom Truck OperatorCertified Crane OperatorOther
Type of PPE Req.*

Hard HatSafety GlassesBootsSafety VestHarnessBack BraceGlovesSkid SteerOther

Project System for Jobsite *

	Stick Build	Blast Mitigation	Hurricane Impact	Unitized
Kawneer
Oldcastle
Tubelite
YKK
Other
Other

Project Systems Being Installed*

All Glass PartitionsGlazingShower DoorsCanopiesCurtain WallDoor HardwareHandrailsHollow Metal FramesLouverMirrorsPanelsSkylightsStorefrontsDoor EntrancesSunshadesResidential WindowsCommercial WindowsBrake MetalCaulkngVentsOther

Equipment Certs Required*

	YES	NO
Industrial Forklift
Boom Forklift
Aerial Work Platform Lift
Swing Stage
Scaffold
Boom Truck/ Crane

Tools Each Independent Subcontractor Must Provide*

Tool BagHammerRubber MalletChannel LocksVice GripsNeedle Nose PliersDuck Bill PliersCutting PliersAdjustable WrenchBattery ImpactBattery DrillSuction CupUtility KnifeVinyl RollerCartridge Gun25' Tape MeasureFile SetScrew Driver SetPry Bar SetSpeed SquareDust BrushAllen Wrench SetOther
ACCOUNTS PAYABLE
Desired Rate Per Hour*
Please List the Desired Rate for This Project.
Desired Payment Terms*
Please List the Net Payment Terms You Are Requesting.
Rates are subject to change if the project has any Insurance Program requirements such as but not limited to LCP tracker, Davis Bacon, CCIP, OCIP, ROCIP. If any of these programs are required Glazier Nation must be notified before the project starts. Because these forms take proper timing to be filled out and completed correctly, Glazier Nation will not be able to rush the process. Glazier Nation must also be notified in advance if the job requires prevailing wages or any fringe benefits. If Glazier Nation is not aware of any program before the start of the project the glass contractor will be held responsible for paying any additional rates/fees to Glazier Nation to meet project requirements.
Drawings & Specs

Browse Files
Please upload any drawings or information that may help with this labor request Cancelof
By submitting this request, you agree to have Glazier Nation supply Pricing Quotes for your Labor Request from the following companies: Glazier Nation & Glaziers On Demand.
Name of Representative*
Person Completing Labor Request
Today's Date*

MonthDayYear
Date
Should be Empty:

LABOR REQUEST FORM