Vendor Registration Form

JUICH LLC | Specialist Network Intake

"Aligning Technical Mastery with Federal Compliance"
- Organization/Business Name
  Enter your Registered Business Name or Legal Name if operating as a Sole Proprietor( Business Name must match Secretary of State/SAM.gov records)
- Company Address (Physical HQ)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Point of Contact
  
  First NameLast Name
- Title
- Phone Number (Day)
  
  Area CodePhone Number
- Professional Email
- Establishment Date
  
  MonthDayYear
  Date
- Business Entity
- Socio-Economics (Please select all socio-economic categories for which your business is CURRENTLY certified or qualifies as a Small Business)
- 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).
- Do your lead field personnel have current OSHA 10 or OSHA 30 certifications?
- Has your firm had any OSHA violations (Serious/Willful), workplace fatalities, or environmental citations in the last 3 years?
- Please describe your on-site safety protocols or equivalent experience."
- Please provide a brief explanation of corrective actions
- Primary Trade & NAICS Classification
  The 6-digit NAICS code is included for Federal compliance and project matching. This helps JUICH LLC align your firm with both Private Commercial and Government opportunities.
- Trade & Technical
- Geographic Service Area
- Do you have past performance to report?
- Past Performance Summary
  Does your organization have at least 3 completed commercial or federal project references from the last 3 years?(Include: Client Name, Scope of Work, and Total Contract Value)
- Project Highlight: Briefly describe a major project the Lead Personnel managed prior to forming this current entity or as a Sole Proprietor.
  Briefly describe 3 similar projects completed within the last 3 years (Include: Client Name, Scope of Work, and Total Contract Value)
- Project Name/Agency (e.g., "HVAC Repair at Ft. Gillem")
- Point of Contact (Name & Email)
- Does your firm provide 24/7 emergency service or rapid mobilization (within 4 hours)?Type a question
- Emergency Response Protocol & Coverage
  Briefly describe your mobilization process (e.g., dedicated on-call team) and your maximum service radius in miles for 4-hour response."
- Total Number of Field Personnel
- Specialized Equipment Owned
- What is your current Experience Modification Rate (EMR)?
  EMR is your "Safety Credit Score." 1.0 is average; below 1.0 is excellent. Check your Workers’ Comp "Dec" page or ask your agent for your "Mod Letter." (New businesses use 1.0).
- Explain why your rate is above the industry average.
- Single Project Bonding Limit ($)
  The maximum contract value your firm is cleared to perform for a single project, as verified by your surety provider.
- Aggregate Bonding Capacity ($)
  The total combined value of all active bonded projects your firm can maintain at one time.
- Surety Company Name
  The name of the underwriting company that issues your performance and payment bonds.
- Surety Agent Name & Email
  Used solely to verify capacity for project-specific bidding requirements.
- Letter of Bondability
  
  A recent letter from your agent confirming these limits. Required for Federal Prime contracts.
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- Insured?
- Licensed?
- License Number
- To maintain eligibility for project awards within the JUICH National Specialist Network, please upload a valid Trade License (e.g., HVAC, Electrical, General Contracting) and a Certificate of Insurance (COI). Insurance Minimums: $1,000,000 per occurrence / $2,000,000 aggregate in General Liability coverage.
  
  Note: If awarded a project, a revised COI naming JUICH LLC as "Additional Insured" will be required prior to mobilization."
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- All JUICH LLC partners must maintain active insurance. Minimum requirements: General Liability ($1M occurrence / $2M aggregate) and Workers' Compensation (or a valid Georgia State Waiver). Please ensure JUICH LLC is listed as an "Additional Insured" on your certificate.
- Individual Track Record Assessment
  At JUICH Consulting, we understand that technical mastery is often held by elite individuals within emerging organizations. By reviewing the Lead Specialist's resume, we can verify the professional 'Critical Path' and high-consequence project history your team brings to our network.
- Lead Technical Resume
  
  Please upload the CV/Resume of the Lead Project Manager or Technical Specialist. Focus on individual experience that demonstrates technical mastery in your primary trade."Allowed File Types: PDF, DOC, DOCX.
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- OSHA 10 or OSHA 30 certifications
  
  Please upload Osha Certifications
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- Capability Statement
  
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- W-9 Tax Form
  
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- Socio-Economic Certification Letter
  
  Please upload your formal certification letter (e.g., SBA WOSB/EDWOSB Letter, VA VOSB Letter, or local DOT certification). If self-certifying as a Small Business, no upload is required.
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- Compliance, Cybersecurity, & Legal Attestation
- I certify that I have reviewed the governing [JUICH LLC | National Terms Of Service] and [JUICH LLC Privacy Policy] and am authorized to bind the firm to these terms.
- By signing below, the Authorized Signatory of {organizationBusinessName} hereby certifies, affirms, and agrees to the following terms as a condition of joining the JUICH National Specialist Network:
  
  Professional Standards & Compliance: All services performed for JUICH Consulting LLC will meet or exceed industry quality standards.
  
  Contractor shall strictly adhere to all applicable ADA (Americans with Disabilities Act) requirements, OSHA safety standards, and local building codes.
  
  Independent Contractor Relationship & Indemnification: Contractor acknowledges that this vetting process and any subsequent project awards utilize independent specialists. No employer-employee relationship is created.
  
  Contractor operates as a separate business entity responsible for its own taxes, insurance, and equipment, and agrees to indemnify JUICH LLC against any claims arising from Contractor’s performance.
  
  Cybersecurity & Data Privacy: Contractor consents to the secure handling of corporate data by JUICH LLC. All information is processed in compliance with FAR 52.204-21, CMMC standards, and Georgia State Privacy Laws.
  
  Contractor agrees to "flow-down" these safeguarding requirements to all personnel and sub-tier contractors assigned to JUICH projects.
  
  Right to Verify & Accuracy: Contractor certifies that all information provided is true and complete.
  
  Contractor authorizes JUICH LLC to verify business standing, insurance, trade licenses, and project references.
  
  Electronic Signature Agreement: Pursuant to the U.S. ESIGN Act and the Georgia Uniform Electronic Transactions Act (UETA), the parties agree that this digital signature carries the same legal weight as a handwritten signature.
- I agree not to bypass JUICH LLC for direct client engagement.
- Name
  
  First NameLast NameTitle
- Date of Execution
  
  MonthDayYear
  Date
- Signature
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JUICH LLC | Specialist Network Intake

Compliance, Cybersecurity, & Legal Attestation