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REGISTRATION / APPLICATION - FORM FOR SMALL WORKS ROSTER

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REGISTRATION / APPLICATION - FORM FOR SMALL WORKS ROSTER
NOTICES: (1) Vendor’s / contractors should complete all portions of this form. (2) The County is not responsible for forms that unclear or incomplete. (3) As per RCW, vendors and contractors may at any time be add to any vendor list(s), or to any small works roster(s), including at the time of submitting a bid for a project. (4) Procurement is not a passive activity. Therefore, in the interest of competition, and in working to ensure the success of County projects, the County may elect to solicit bids from any vendor by posting its solicitations to the County’s website and the County may concurrently and at any time supplement vendor lists or rosters by proactively researching and adding vendors/contractors to vendor list(s) and small works rosters. (5) Completing this form is NOT the same thing as subscribing to automatic notifications from the County’s website.
This completed form is intended for (but not necessarily limited to) the following:
1. Vendor List(s) for Materials, Supplies and Equipment; and/or
1. Small Works Roster(s) for small public works construction, repair, or maintenance projects
NOTE TO CONTRACTOR: Are you able to receive specifications via e-mail (MS Word or Excel files)?
1. Yes
2. No
SECTION 1 - VENDOR/CONTRACTOR INFORMATION
Firm Name:*
Contact:*
Address*
"Remit-To" Address (if different)
City*
State*
Zip Code*
Telephone Day:*
Telephone Night:*
Fax Number:
Email Address:
Vendor's/Contractor's Website (URL):
Washington State Contractor's License No.:*
Washington State UBI No.:
Tax Payer Identification Number (TIN):
Washington State Employment Security Reference Number:
Bonded with: *
Liability Insurance with:*
SECTION 2 - VENDOR LIST(S)
NOTICE: Vendor’s that sell or furnish goods (materials, supplies and equipment or services) should complete this Section 2, by checking any and all boxes that apply.
Print or Type Complete Company Name: *
Description of Goods/Services:*
Provide a complete written description of all the goods and or services that are provided by your company or firm:
List any and all brand names of products or services that are sold or furnished by your company or firm:
PLACE A CHECK (√) ONLY IN THE CATEGORIES THAT APPLY TO YOUR FIRM’S EXPERTISE AND FOR WHICH YOU WANT TO BE ROSTERED.
1. SWR100 - Aerial Crane Service
1. SWR127 - Mechanical (HVAC)
1. SWR101 - Asphalt Paving / Patching / Sealing (Parking Lots)
1. SWR128 - Mobile Home Movers
1. SWR102 - Asphalt Paving / Patching / Sealing (Roads)
1. SWR129 - Painting (General)
1. SWR103 - Boiler Maintenance and Repair
1. SWR130 - Pavement Striping, Legends and Marking
1. SWR104 - Bridge Construction / Reconstruction / Rehabilitation
1. SWR131 - Pavement Sweeping
1. SWR105 - Cabinet Making
1. SWR132 - Pool Services, Including Pool Draining
1. SWR106 - Carpentry
1. SWR133 - Railroad Track Construction & Repair Svcs
1. SWR107 - Cement Treated Base Roadways
1. SWR134 - Retaining Walls
1. SWR108 - Concrete Curb, Gutter and Sidewalk
1. SWR135 - Roadway Construction
1. SWR109 - Concrete Cutting
1. SWR136 - Roof, Re-Roof and Roof Maintenance
1. SWR110 - Concrete / Masonry (including masonry fences)
1. SWR137 - Sanitary Sewer Construction
1. SWR111 - Concrete, Pre-cast Supply & Erection
1. SWR138 - Security System Equipment and Installation
1. SWR112 - Crack Sealing
1. SWR139 - Septic System Services Including Pumping
1. SWR113 - Demolition
1. SWR140 - Sign Installation, Non-Electrical (traffic)
1. SWR114 - Drilling, Core and Rotary (including water wells)
1. SWR141 - Slurry Sealing
1. SWR115 - Dust Control and Abatement
1. SWR142 - Stormwater Fac Install, Replace & Renovate
1. SWR116 – Electrical (Construction & Traffic)
1. SWR143 - Street Illumination
1. SWR117 - Erosion Control
1. SWR144 - Stump Grinding and Removal
1. SWR118 - Excavation, Fill Material and Grading
1. SWR145 - Tank Installation, Replace & Renovate
1. SWR119 - Fencing (non-masonry)
1. SWR146 - Traffic Control
1. SWR120 - General Contracting (Construct, Renovate, Remodel)
1. SWR147 - Tree Trimming and Brush Removal
1. SWR121 - Guardrail Replacement and Repair
1. SWR148 - Underwater Diving Work/Diving Services
1. SWR122 - Hydro-seeding
1. SWR149 - Welding and Metal Fabrication
1. SWR123 - Irrigation and Sprinkler Systems
1. SWR150 - Well Decommissioning Service
1. SWR124 - Landscaping (General)
1. SWR 151 - Plumbing
1. SWR125 - Landscaping (Streamside Enhancement)
1. SWR 152 – Roll-up/Overhead Door Installation
1. SWR126 - Logging
1. SWR 153 – Flooring Services