1. REQUEST TO BE INCLUDED ON THE
  2. PROFESSIONAL SERVICE ROSTER
    1. EVERETT SCHOOL DISTRICT NO. 2
    2. PURCHASING OFFICE

REQUEST TO BE INCLUDED ON THE

REQUEST TO BE INCLUDED ON THE

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PROFESSIONAL SERVICE ROSTER

PROFESSIONAL SERVICE ROSTER

 

EVERETT SCHOOL DISTRICT NO. 2

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       State      Zip      E-mail  

 

Name of Contact Person    

 

Federal Tax Identification Number:  

 

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 02/17/04

 

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