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Subcontractor Agreement 1 Page 6
Subcontractor Agreement 1
Border Construction Services
SUBCONTRACTOR APPLICATION
DATE: ________________ TAX ID # __________________________
NAME__________________________________________________________________
DBA (if applicable) _______________________________________________________
ADDRESS ______________________________________________________________
CITY ___________________________________STATE ________ ZIP_____________
PHONE ( ) ______________________ HOME ( ) ____________________________
EMAIL ADDRESS _______________________________________________________
YEARS IN BUSINESS_____________ YEARS AT THIS ADDRESS ______________
DRIVER’S LICENSE NUMBER _______________________________ STATE ______
SOCIAL SECURITY NUMBER ____________________________________________
BANK REFERENCE _____________________________________________________
ACCOUNT # ____________________________________________________________
INSURANCE COVERAGE
GENERAL LIABILITY ___________________________ LIMITS _________________
WORKERS’COMPENSATION_____________________ LIMITS _________________
AUTOMOBILE __________________________________LIMITS _________________
CERTIFICATES OF INSURANCE OR APPROPRIATE WAIVERS MUST BE
ON FILE IN THIS OFFICE PRIOR TO ANY WORK STARTING
LIST LEAD SUPERVISORY PEOPLE YOU WILL ASSIGN TO OUR JOB SITE
NAME PHONE/ PAGER # VEHICLE MAKE & LICENSE
TRADE CREDIT REFERENCES – MINIMUM OF THREE IN LOCAL AREA
NAME ___________________________________ PHONE_______________________
ADDRESS ________________________________ CONTACT____________________
CITY _________________________ STATE _____ ANNUAL PURCHASE_________
NAME ___________________________________ PHONE ______________________
ADDRESS ________________________________ CONTACT ___________________
CITY _________________________ STATE _____ ANNUAL PURCHASE _________
NAME ___________________________________ PHONE ______________________
ADDRESS ________________________________ CONTACT ___________________
CITY _________________________ STATE ______ ANNUAL PURCHASE ________
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