Small Works Roster Application

Central Valley School District, #356

Small Works Roster Application

Central Valley School District invites qualified contractors to register to be notified of upcoming bids. The District uses the roster to invite contractors to bid on small public works projects. General qualifications for bidding on a project include:

Contractor must hold a valid Washington State contractor's license
Contractor must pay Washington State prevailing wages on all projects and provide proper documentation
Contractor must provide performance and payment bonds prior to commencing work
Contractor must have worker's compensation insurance as required by Washington State law and premium payments must be current and claims rate must be good
Contractor must meet the following insurance requirements:

Limits of general liability insurance of at least $1,000,000 per occurrence;
$1,000,000 aggregate, Combined Single Limit (CSL);
Automobile liability of at least $1,000,000 per accident CSL; and
The ability to name the District as an additional named insured, after the award of a bid

INSTRUCTIONS

Complete ALL information below by typing, print out, sign, and fax the form to (509) 228-5479.
Formatting of certain fields is important and examples are provided, # = Number, L=Letter, &=Number or Letter

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Check here if updating your current application on file
Company Name
Local Contact Person
E-Mail Address
Website Address
Telephone Number
Telephone Extension
Fax Number
Cell Number
Mailing Address
City
State
Zip

Business Type	Corporation Partnership Sole Proprietorship
Federal Tax ID Number	(# # - # # # # # # #)
Washington State Contractor's License (Registration) Number	(L &&&&&& # # # & &)
Washington Unified Business Identifer (UBI) Number	(# # # # # # # # #)
Washington Labor and Industries Insurance Number	(# # # , # # # - # #)
If you don't have Washington L&I Insurance, why not?
Check if you will pay Washington State prevailing wages
Year your business opened under this name	(# # # #)
Number of Employees	(# # # # #)
Check if this company has worked for the District before
If so, what was the project the company worked on and when
Check if you are an Equal Opportunity and Affirmative Action employer
BONDING
Check if you will provide performance and payment bonds
Name of bonding compay
Address of bonding company agent (Address, City, State, Zip)
LIABILITY INSURANCE
Check if you will meet the liability insurance requirements above
Name of insrance company
Address of insurance company agent (Address, City, State, Zip)
Explain any missing information above, all fields are required.

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BUSINESS REFERENCES

List related contracts you have performed in the categories you select below.

	Company	Contact Phone / Person	Contract Number / Name
1
2
3

CATEGORIES OF WORK

For each of the categories below, check all that your company is able to perform and would like to be notified about.

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	A)	Acoustic Treatments
	B)	Alterations
	C)	Architectural Firm
	D)	Asbestos / Lead Abatement
	E)	Boiler Installation / Repair / Cleaning
	F)	Building
	G)	Cabinet Maker
	H)	Concrete
	I)	Contaminated Soil Removal
	J)	Demolition
	K)	Dry Wall
	L)	Electrical (high and low voltage)
	M)	Environmental Studies
	N)	Excavating
	O)	Fence
	P)	Floor Laying / Refinishing / Resurfacing
	Q)	Foundation
	R)	General
	S)	Heating / Ventilation / Air Conditioning (HVAC)
	T)	Insulation
	U)	Irrigation / Landscape
	V)	Masonry
	W)	Mechanical
	X)	Painting
	Y)	Paving
	Z)	PLAN HOLDER's CENTER (Plan Centers Only)
	AA)	Plastering
	AB)	Plumbing
	AC)	Radon Mitigation
	AD)	Roofing
	AE)	Sandblasting
	AF)	Security Systems
	AG)	Sewer
	AH)	Sheet Metal Work
	AI)	Spraying / Horticultural Work
	AJ)	Storm Drain
	AK)	Tile / Ceramic
	AL)	Tree Service
	AM)	Upholstery

APPLICATION SUBMISSION

Your Name (Approving Authority)
Your Title
Current Date	(# # / # # / # # # #)
INSTRUCTIONS	Print this page, insure all text prints, sign below, and fax to (509) 228-5479. No cover page is necessary. Keep a copy of the application in case the first fax is illegible and must be refaxed. If your browser doesn't support properly displaying this information, print the blank document, complete in writing, and fax.

SIGNATURE (required)

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