NuJak Subcontractor Interest Form

NuJak Subcontractor Interest Form

Thank you for your interest in partnering with NuJak! Please provide your company details below to join our subcontractor network.
Section 1: Company Information
Legal Business Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Website
DBA / Trade Name
Federal Tax ID / EIN
Physical Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Main Phone
Please enter a valid phone number.Format: (000) 000-0000.
Company Email
example@example.com
Primary Contact Name
Primary Contact Title
Primary Contact Direct Phone
Please enter a valid phone number.Format: (000) 000-0000.
Primary Contact Email
example@example.com
Company Type
Business Structure
Years in Business
Employees
Labor Affiliation
Service Area / States
Supplier Diversity Certification
Certification details / number
Corporate Officers/Partners
Section 2: Licensing, Insurance & Safety
Primary Trade / License Type
License Number
License State
License Expiration

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Additional Licenses
Insurance Carrier
Agent / Broker Name
Agent Phone
Please enter a valid phone number.Format: (000) 000-0000.
Bonding
Surety / Bonding Company
Surety Contact
Available Capacity
EMR - Current Year
EMR - Prior Year
EMR - Two Years Prior
OSHA Recordables - 3 Years
Safety Questions
Safety Contact Name
Safety Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Safety Contact Email
example@example.com
Disclosure Question
Explain "Yes" Response
Section 3: Experience & References
Financial Capacity: Year
Financial Capacity: Annual Revenue
Financial Capacity: Largest Contract
Financial Capacity: Current Backlog
Section 4: Trade Categories
Project References
List each project on a new line. Include project name, location, completion date, contract value, owner/GC contact, and brief scope.
Trade Categories Performed
Other Trade Category
Section 5: Insurance & Licensing
Certificate of Insurance (COI)

Cancelof
COI Expiration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Workers Compensation Document

Cancelof
Workers Comp Expiration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Business License

Cancelof
Business License Expiration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Business Tax Receipt

Cancelof
Business Tax Receipt Expiration

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
If Business Tax Receipt is not applicable, explain
W-9

Cancelof
Contractor License(s)

Cancelof
Safety Program / EMR Letter

Cancelof
Bonding Letter

Cancelof
Optional Supporting Documents

Cancelof
Section 6: Certification & Renewal Contact
Renewal Contact Name
Renewal Contact Email
example@example.com
Renewal Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Electronic Certification Agreement

Upload the completed certification agreement.
Cancelof
Authorized Representative Name
Authorized Representative Title
Certification Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

NuJak Subcontractor Interest Form

Section 1: Company Information

Section 2: Licensing, Insurance & Safety

Section 3: Experience & References

Section 4: Trade Categories

Section 5: Insurance & Licensing

Section 6: Certification & Renewal Contact