Form with Excel

Business & Contact Details

Legal Business Name *

Trading Name (DBA)

Owner's Full Name *

Phone *

E-mail *

Address 1 *

Address 2

City *

State *

Zip *

State Business Registered (check all that applies) *

Union Affiliated Contractor

Yes No

Business Type

Business Website (ex. https://yourwebsite.com)

Business Facebook Name (Handle)

Business Instagram Name (Handle)

Business X Name (Handle)

Insurance & Safety Information

Do you have the following insurance? (check all that applies)

For a sample of our insurance requirements click here

What is your current Experience Modification Rate(EMR)?

Note: You must provide confirmation of your last 3 years EMR on insurance letterhead as proof. Your insurance agent will be able to easily provide you with this.

Does your company have any OSHA safety violations in the last 5 years?

Yes No

If yes provide details here

Does your company have any pending OSHA complaints or fines?

Yes No

If yes provide details here

Documents

Copies of all training certificates

Certificates of insurance View example COI form click here

ACH form View example ACH form click here

W9 form View example W9 form click here

EMR Letter

Licensing and Certifications

Do you or your employees have the following (check all that applies) *

Note: Copies of all certificates must be provided as proof of training

Does your business hold any of the following Lead Paint certifications? (check all that applies) *

Are you licensed to perform commercial painting? Select the states that are licensed to perform commercial painting? Number of years?

Are you licensed to perform residential painting? Select the states that are licensed to perform residential painting? Number of years?

Work Experience & Availability

Geographical Coverage (check all that applies)

Availability (check all that applies)

How many employees do you have?

How many employees understand & speak English well?

How many employees (including yourself) are US citizens?

Do you have your own vehicle? (check if applicable) Is your vehicle a plain white van or truck with no lettering?