Vendor Registration Form

Specialist Network Intake

Complete form below to signup as a subcontractor.
Technical Partner Compliance and Vetting :
Organization/Business Name
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Point of Contact

First NameLast Name
Phone Number (Day)

Area CodePhone Number
Phone Number (Evening)

Area CodePhone Number
E-mail
Company Overview
Establishment Date

MonthDayYear
Date
UEI / CAGE Code (If applicable)
If you do not have these, please enter "N/A." (Note: JUICH LLC can assist high-performing partners with the registration process upon project award).
Primary NAICS Codes (e.g., 238220 for HVAC, 561720 for Janitorial)
Socio-Economic / Business Categories (Check all that apply)

Small Business (SB)Small Disadvantaged Business (SDB)Women-Owned Small Business (WOSB)Economically Disadvantaged WOSB (EDWOSB)Veteran-Owned Small Business (VOSB)Service-Disabled Veteran-Owned (SDVOSB)HUBZone Certified8(a) Program ParticipantLarge Business / Other
Business Type (Check all that apply)

LLCS-CorpC-CorpSole Proprietorship / Independent Contractor (This is the "1099" category)Partnership
General Details of Services/Goods
Geographic Service Area
Insured?

Yes
Licensed?

YesNo
License Number
Please attach a copy of your current Trade License and COI (Certificate of Insurance).

Cancelof
Relationship Disclaimer Submission of the Specialist Network Intake form constitutes an application for inclusion in the JUICH LLC Vetted Partner Database. It does not create a contract, partnership, joint venture, or employer-employee relationship between JUICH LLC and the applicant. Inclusion in the network does not guarantee a contract award or a promise of future work. Any future engagement will be subject to a separate, formal Subcontractor Agreement and a specific Project Work Order.

I hereby affirm that all information provided above is accurate to the best of my knowledge and belief, and I understand that this information will be considered material in the evaluation of quotations, bids and proposals.
I acknowledge and accept the Relationship Disclaimer above.*

I Agree
I affirm that all information provided is accurate to the best of my knowledge.*

I Agree
Quality Commitment & Safety Alignment: I/We hereby agree to adhere to the JUICH LLC Quality Control Plan (QCP) and all project-specific safety protocols. I understand that all work performed must meet JUICH’s 'High Impact' standards and is subject to federal compliance inspections."*

I Agree
Date

MonthDayYear
Date
Company Representative Signature
Should be Empty:

Specialist Network Intake

Technical Partner Compliance and Vetting :

Company Overview