1. Purchasing Office


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     REQUEST TO BE INCLUDED ON


    THE SMALL WORKS ROSTER


     


     

     

     





    Purchasing Office

    P.O. Box 2098

    Everett, WA 98213

    Phone: (425) 385-4180

    Fax: (425) 385-4172


     

    In compliance with RCW 39.04.155, the undersigned requests to be added to the Everett School District's Small Works Roster which will be used in soliciting proposals on public works projects not exceeding $350,000 in cost. It is understood that if no response is received on three successive requests for proposals a contractor may be removed from the roster. A written "no proposal" response will be considered a response. Contractors included on the small works roster must provide annual information updates or be subject to removal from the roster.

     

     
    Name of Company Phone #      
     
    Address
     
    Fax #
       
     
    City StateZipE-mail
         


     
    Name of Contact Person
       


     
    Washington State Contractor's License #
     
    Expires
       


     
    Federal Tax Identification # UBI #
       


     
    Bonded with: Phone #
       


     
    Liability Insurance with: Phone #
       


     

     
    Type of Organization: [ ] Individual [ ] Partnership  [ ] Corporation
    List principals: (owners, partners, corporate officers)
     
    Name & Title
         
     
    Name & Title
         
     
    Name & Title
         


     
    How long has your company been in business?
       


     

     
    Continued on Reverse Side

    Contracts completed within last two years (project, owner, contract amount)

                               

                               

                               

     

    References (name, company, phone number)

                               

                               

                               

     

    Mark with an X those project types that you are equipped, experienced and qualified to perform:

     

    [ ] Asbestos Abatement  [ ] Fencing          [ ] Painting

    [ ] Cabinetry      [ ] Floor Coverings        [ ] Paving

    [ ] Concrete Work    [ ] General Contractor-Building    [ ] Roofing

    [ ] Demolition    [ ] General Contractor-Site Work    [ ] Utilities

    [ ] Electrical      [ ] Heating, Ventilation, Air Conditioning

    [ ] Equipment Installation  [ ] Portable Classroom Relocation

    [ ] Others                          

     

    Comments or explanations, if any, on areas of specialization:            

                               

                               

     

    Applicant agrees to comply with prevailing wage requirements of the State of Washington Department of Labor and Industries on all District projects.

     

    Applicant agrees to provide a Certificate of Insurance naming the Everett School District as an additional insured, prior to commencement of any project.

     

    Applicant agrees to comply with all City, State and Federal regulations relative to public works projects.

     

     

    I certify that the information supplied herein is correct and agree to the terms and conditions contained herein.

     

     

    Signature Date
         
     
    Printed Name Title
       


     

     

    Revised 1/07/20

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