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Debris Management Sub-Contractor Preliminary Registration Form

Company Name
Contact Person:
First Name
Last Name
Your Position or Title
Email Address
Company Website
Company Address
City
State/Province
Zip Code
County
Tax ID#
DUNS#
E-Verified #
Phone Number
Cell Phone Number
Fax Number
Owner Name
Please Note Insurance Requirements
General Liability limit of 1 Million
Commercial Auto limit of 1 Million
Workers Compensation
___________________________________
Type of Business-Federal Certification
(check all that apply)

For all certifications not related to company size/revenue, proof of such certifications must be provided.

Large Business (over $11.5 million
       in revenue annually)
Small Business (under $11.5 million
       in revenue annually)
Woman-Owned Business
Small Disadvantaged Business
      (As defined in 13 CFR 124.1002)
HUB Zone Owned
Veteran Owned
Service Disabled Veteran
Other MBE Certified:

Experience
Type of Work performed
Number of Years
List companies worked for/under during past events
Project manager(s) worked under
How was your experience under
our (CG) Project manager(s)?

Please fill-in the number of pieces of equipment you have for each type of equipment listed below:

Description of Equipment
Number of Pieces
1.
Dump Truck, 16-24 yd3 Capacity
2.
Dump Truck, 25-45 yd3 Capacity
3.
Dump Truck, 46-65 yd3 Capacity
4.
Pickup truck w/ Dump Trailer
15-20 yd3 Capacity
5.
Knuckle boom, Prentice-Style/Self-Loader, 10,000 lb. Capacity
6.
Wheel Loader, 50HP 1yd Capacity
7.
Wheel Loader, 100HP 2yd Capacity
8.
Wheel Loader, 150HP 4yd Capacity
9.
Truck Pickup, .5 Ton
10. Hydraulic Excavator, 50HP, w/bucket & Grapple/Thumb
11. Hydraulic Excavator, 100HP, w/bucket & Grapple/Thumb
12. Hydraulic Excavator, 150HP, w/bucket & Grapple/Thumb
13. Trailer Mounted Flood Light Set  with Generator Unit
14. Low-bed trailer with tractor
15. Water Truck - min. 3,000 Gal.
16. Air Curtain Burner, min. nozzle velocity of 8,800 ft/min(100mph) and volume of 900 cf/min/linear ft.
17. Backhoe, with loader, 1.5 yd3 Capacity, with thumb attachment
18. Dozer, tracked 2-3 yd3 Blade Capacity
19. Dozer, tracked with root rake blade, D7 or equal
20. Grader, Motor, 12 foot blade,     130-140 net HP
21. Chipper, with 12 inch minimum
22. Tub Grinder 800-1,000HP
23. Tub Grinder, 300-400HP
24. Self loading truck, 20-30 yd3 Capacity
25. Self loading truck, 30-40 yd3 Capacity
26. Skid steer loader, 40HP, w/grapple
27. Skid steer loader, 60HP, w/grapple
28. Skid steer loader, 80HP, w/grapple
29. 80-110 yd3C&D Walking Floor
30. 30-80 yd3Mulch Trailer
31. Bucket Trucks
32. Barges
33. Workboats
34. Vac Trucks

  Push Crews - (Supply personnel and equipment to clear roadways as first response to a storm)

 

Additional Resources - Please list any Other Equipment
 

Type the two words below


All Subcontractors are required to enroll in the E-Verify program and provide acceptable evidence of enrollment at the time of any Subcontract execution. Acceptable evidence consists of a copy of the properly completed E-Verify Company Profile page or a copy of the fully executed E-Verify Memorandum of Understanding for the company. For additional information regarding the Employment Eligibility Verification System (E-Verify) program visit the following website:
http://www.dhs.gov/E-Verify. It shall be the Subcontractor’s responsibility to familiarize themselves with all rules and regulations governing this program.

This form is only a preliminary step in the process of hiring potential contractors.
Completion of this form does not guarantee employment.

 

 
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