SUBCONTRACTOR APPLICATION Please complete this form to be considered to supply products or services to Caesar's Roofing, Inc. Completing this form does not guarantee that you will be approved to bid or work as a subcontractor or supplier. Please submit completed forms by e-mail to [email protected], fax to (781) 325-4155, or mail to P.O. Box 1184, Lynnfield, MA 01940. A member of our staff will contact you once we receive it. Thank you! COMPANY INFORMATION Name: Business Name:

Title:

Address: Tel:

Fax: Website:

E-mail: Company Type:

____ Sole Proprietorship

____ C Corporation

Tax ID / EIN: Years in Business:

____ S Corporation ____ Partnership

D-U-N-S: CAGE/ NAICS:

Contractor's License No:

State:

Exp:

Total No. of Employees: BUSINESS CLASSIFICATION Please indicate if any of the following categories are applicable to your company & please submit any certificates in suport of the categories you select. Certified Small Business

HUBZone Small Business

Small Disadvantaged Business

Alaska Native Corporation (ANC)

Woman-Owned Small Business

Business

Service- Disabled Veteran-Owned Small Business

Alaska Native Corporation

Historically Black College & Minority Instutions Disabled Veteran Business Enterprise Veteran Owned Small Business Is your company registered with the government's System for Award Management (SAM)?

Yes

No

SUBCONTRACTOR APPLICATION Page 2 of 3

INSURANCE COVERAGE Please submit evidence of coverage for the policies listed below. General Liability:

Limits:

Workers Comp:

Limits:

Automobile:

Limits:

SERVICES PERFORMED If you are qualified and interested in providing one or more of the services, below please indicate by placing an X next to those services. Asbestos Abatement

Lanscape Design, Installation, & Management

Building Management Systems

Material Supplier

Carpentry

Metal Fabrication

Electrical System Installation & Repair

Pavement

Fire Alarms & Protection

Plumbing

Floor Installation & Maintenance

Sound System & Audiovisual Equipment

Hard Surface Cleaning & Pressure Washing

Other: _______________________________

HVAC Kitchen/ Bathroom Renovation PROJECT REFERENCES 1. Client: Address: Phone:

E-mail:

Work Performed: 2. Client: Address: Phone: Work Performed:

E-mail:

SUBCONTRACTOR APPLICATION Page 3 of 3

3. Client: Address: Phone:

E-mail:

Work Performed: SIGNATURE I, ____________________________ of ____________________________ , have reviewed the foregoing information. This information is being provided for the intent of supplying services and/ or materials to Caesar's Roofing, Inc. All of this information contained herein is correct and complete to the best of my knowledge. SUBCONTRACTOR

Date

By: ___________________________________________ Its: ___________________________________________