1. REQUEST TO BE INCLUDED ON THE
  2. SMALL WORKS ROSTER
  3. EVERETT SCHOOL DISTRICT NO. 2
    1. PURCHASING OFFICE

REQUEST TO BE INCLUDED ON THE

REQUEST TO BE INCLUDED ON THE

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SMALL WORKS ROSTER

SMALL WORKS ROSTER

 

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EVERETT SCHOOL DISTRICT NO. 2

EVERETT SCHOOL DISTRICT NO. 2

PURCHASING OFFICE

P.O. BOX 2098

EVERETT, WA 98213

PHONE: (425) 385-4180

FAX: (425) 385-4172

 

 

In compliance with RCW 28A.335.190, 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 $200,000 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       State      Zip      E-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 3/1/01

 

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