1. Purchasing Office


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     REQUEST TO BE INCLUDED ON THE


    PROFESSIONAL SERVICES ROSTER


     


     

     

     

     

     

     





    Purchasing Office

    P.O. Box 2098

    Everett, WA 98213

    Phone: (425) 385-4180

    Fax: (425) 385-4172


     


    FOR CONSIDERATION ON SPECIAL PROFESSIONAL SERVICES PROJECTS

    COMPLETE THIS FORM AND MAIL TO THE ABOVE ADDRESS.


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


     
    Name of Contact Person
       


     
    Federal Tax Identification #
       


     
    Type of Organization: [ ] Individual [ ] Partnership  [ ] Corporation
    List principals: (owners, partners, corporate officers)
     
    Name & Title
         
     
    Name & Title
         
     
    Name & Title
         
    Are any of the Principals or their spouses employed by the Everett School District #2?
    [ ] Yes [ ] No


     
    How long has your company been in business?
       


     

    PREVIOUS EXPERIENCE – List other school districts or state agencies:

     

    District/Agency    Description of Service    Date Performed  Amount  

                               

                               

                               

                                                                                       

     


    Continued on Reverse Side

    EVERETT SCHOOL DISTRICT IS AN EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION EMPLOYER. Applicant will comply with all City, State and Federal Government regulations regarding equal employment opportunity and affirmative action.

    Mark with an X those services you are equipped, experienced and qualified to perform:
    [ ] Architecture [ ] Engineering Structural
    [ ] Architecture, Landscaping [ ] Engineering, Traffic/Transportation
    [ ] Asbestos Abatement Consultant [ ] Engineering, Value
    [ ] Construction Testing [ ] Environmental Monitoring
    [ ] Cost Estimating: [ ] Hazardous Waste Services
    [ ]  · Roofing [ ] Inspection Services
    [ ]  · Commissioning HVAC Systems [ ] Survey
    [ ]  · A.D.A. Upgrades [ ] Testing & Balance of HVAC
    [ ]  · Constructability Reviews [ ] Testing & Concrete
    [ ] Engineering, Civil [ ] Testing, Soil
    [ ] Engineering, Electrical [ ] Other :  
    [ ] Engineering, Geo-Technical [ ]       
    [ ] Engineering, Mechanical [ ]      
    [ ] Engineering, Signal Systems [ ]      

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

                               

                               

     

    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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