Introduction
Company Name:
Address:
Would you like to add a second location?
Address:
Phone:
Format: (000) 000-0000.
Website:
Business Type
Labor Type:
Percentage of work is commercial construction:
Percentage of work that is normally subcontracted:
Scope Of Work
What scope of work do you perform:
Ownership/Business Structure
Corporation Type:
State of Incorporation:
Date of Incorporation:
Has your company ever done business under a different name?
DBA Information:
Is your company owned or controlled by a parent company?
Provide Parent Company Information
Employees
Estimators
Field Supervisors
Tradespeople
Clerical/Accounting
Other
Total
Owners/Officers of Your Company
Name (Owner/Officer)
Email
example@example.com
Phone
Format: (000) 000-0000.
Would you like to add additional Officers?
Name (Owner/Officer)
Email
example@example.com
Phone
Format: (000) 000-0000.
Company Contacts
Who should we send Invites to Bid (ITBs) to?
Who should we send Billing and Invoices to?
Who should we send Release Requests to?
Who should we sent Contracts, Change Orders, Etc. to?
What is the email address of your ITB contact?
example@example.com
What is the email address of your Billing contact?
example@example.com
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What is the email address of your Release Request contact?
example@example.com
What is the email address of your Contracts contact?
example@example.com
Licensing
License Number
Classification
Issuing Agency
State Issued
License Number
Classification
Issuing Agency
State Issued
License Number
Classification
Issuing Agency
State Issued
Certified Business Enterprises Certifications
Please select Enterprise type
Other Enterprise type
Health and Safety
Does your company have a safety program?
Please upload a copy of your safety program.
Does your company have a safety officer or department?
Safety Officer
Safety Officer Email
example@example.com
Safety Officer Phone
Format: (000) 000-0000.
Please list your workers compensation Experience Modification Rate (EMR)for the last (3) years:
Please attach your Insurance Agent's EMR Verification Letter:
Does your company have a substance abuse program?
Please upload your company's substance abuse program.
Has your company had any OSHA citations or jobsite fatalities within the last (5) years?
Please explain the incident:
Bonding & Surety
Are you able to provide bonding for projects?
Please attach your bond/ surety letter
Insurance
Name of your insurance company?
Agency Contact Name
Agency Email
example@example.com
Agency Phone
Format: (000) 000-0000.
Would you like to add an additional company and contact?
Name of your additional insurance company?
Additional Agency Contact Name
Additional Agency Email
example@example.com
Additional Agency Phone
Format: (000) 000-0000.
Is your company a surveying or testing company?
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Attach your Omissions Professional and Liability Insurance Certificate
General Liability
Attach your Commercial General Liability Insurance Certificate
Workers Compensation
Attach your Worker's Compensation Insurance Certificate
Automobile
Attach your Commercial Automobile Liability Insurance Certificate
Financials
Should be Empty: