RYAN COMPANIES US, INC. VENDOR REGISTRATION FORM

Transcription

1 RYAN COMPANIES US, INC. VENDOR REGISTRATION FORM COMPANY NAME: MAIN PHONE #: ADDRESS: MAIN FAX #: CITY STATE ZIP CONTACT WEBSITE: SUBCONTRACTOR LICENSE NUMBER (if applicable): I. ORGANIZATION A. How many years has your organization been in business as a subcontractor? B. Inclusion Classification, is your business certified as: Self-Certified VOSB Veteran-Owned Small Business Self-Certified SB Small Business Self-Certified SDB Small Disadvantaged Business Self-Certified SDVOSB Service-Disabled Veteran Owned Small Business Self-Certified HZSB HUBZone Business Self-Certified WOSB Women-Owned Small Business Self-Certified EDWOSB Economically Disadvantaged Women-Owned Small Business Third Party DBE Disadvantaged Business Enterprise Third Party MBE Minority Business Enterprise Third Party MBE National Supplier Diversity Council Third Party TGB Targeted Business Group Third Party SBE Small Business Owned Enterprise Third Party WBE Women Business Enterprise Third Party WBE Women Business Enterprise National Council Pending Certification NONE If your business is certified, please send a copy of your Certification(s) and/or SAM.gov FAR Report forms when submitting the Vendor Registration Form. This ensures we have proper documentation regarding your certifications. If forms are not submitted, we will not update this field in our system. C. Approximate Annual Sales Volume for the past 3 Years: D. Scope of Work your company performs: (Check all that apply on attached CSI 2004 list) E. Union Affiliations:

2 II. REFERENCES A. Supplier References (Minimum of Three Major Suppliers): Company Name: Address: City: State: Zip: Phone: Fax: Company Name: Address: City: State: Zip: Phone: Fax: Company Name: Address: City: State: Zip: Phone: B. Bank Reference: Contact: Company Name: Address: Fax: City: State: Zip: Phone: III. INFORMATION REQUIRED A. Please have your bonding company provide a letter containing the following information (example attached): 1. Your current bonding limit. 2. Your current unutilized bonding capacity (bonding limit less current bonds outstanding). 3. A statement indicating your bonding company's willingness to bond your company on this project. -OR - B. If you are unable to provide us with a letter from your bonding company, please provide us with a current financial statement (including both Balance Sheet and Income Statement) for your most recent fiscal year. Also, return the Authorization to Release Credit Information form. C. Please have your insurance agent provide us with a letter stating your Worker s Compensation Experience Rate Modifier for the past three years (example attached). If current year s mod rate is over 1.0, Ryan s Safety Director may contact your company to discuss. D. Please list any serious OSHA violations that your business may have received during the last 3 years. E. Please complete and return the attached W-9 Request for Taxpayer Identification Number and form. F. Are you a sole proprietor? Yes No If yes and you are a Minnesota vendor doing work in Minnesota, please provide an Independent Contractor Exemption Certificate (ICEC). G. Please provide us with a blanket certificate of insurance. A sample indicating our requirements is attached. Fax: Vendor Registration Form Date Revised:

3 H. Please list the Cities and/or States that your Company performs works in. I. Please place a checkmark next to your company s market expertise: Airports High-Rise Light Office Towers Shopping Malls Buildings Commercial Biofuels Heavy Light Industrial Parking Structures Senior Housing Industrial Bridges Hospitals Low-Rise Prisons Solar Buildings Condominiums Hospitality Marine Residential Tenant Improvement Distribution Highways Medical Office Retail Wind Centers Buildings Heavy Civil Labs Mission Critical Schools J. Please provide a list of contacts within your company you wish to have added to our database including their title, direct fax/phone numbers and addresses. The Undersigned certifies that the information provided herein is true and sufficiently complete so as not to be misleading. By: By: Signature Print or Type Name & Title Vendor Registration Form Date Revised:

4 CSI Master Format 2004 Scope of Work Check all that apply Final Cleaning Demolition Selective Demolition Contaminated Site Material Removal Concrete Materials Concrete Forming and Accessories Concrete Reinforcing Reinforcing Steel Detailer/Rebar Erection Cast In Place Concrete Concrete Slab on Grade Placement Post Tensioned Concrete Precast Structural Concrete Precast Concrete Hollow Core Planks Precast Architectural Concrete Tilt-Up Concrete Cast Decks & Underlayment Grouting Concrete Cutting & Boring Ready Mix Concrete Concrete Pumping Unit Masonry Brick Masonry Concrete Unit Masonry Stone Assemblies Manufactured Masonry Structural Steel Framing Steel Erection Steel Joist Framing Metal Decking Cold Formed Metal Framing Metal Fabrications Decorative Metal Rough Carpentry Wood Trusses Lumber Wood Framing Heavy Timber Construction Finish Carpentry Architectural Woodwork Sold Surfacing Fabrications Glass Fiber Reinforced Plastic Roof Repairs Damping & Waterproofing Fluid Applied Waterproofing Traffic Coatings Thermal Insulation Exterior Insulated Finish Systems Shingles & Shakes Roofing & Siding Panels Wall Panels Built-up Bituminous Roofing Metal/Special Roofing EPDM Membrane Roofing Thermoplastic Membrane Roofing Standing Seam Sheet Metal Roofing Sheet Metal Flashing & Trim Roof Specialties Roof Accessories Applied Fireproofing Firestopping Joint Sealants Expansion Joint Control Metal Doors and Frames Wood Doors Plastic Doors Access Doors and Panels Sliding Glass Doors Coiling Doors & Grilles Overhead Coiling Doors Special Function Doors Folding Doors & Grilles Panel Doors Traffic Doors Pressure-Resistent Doors Entrances & Storefronts Entrance Storefronts Curtainwall & Glazed Assemblies Windows Wood Windows Roof Windows & Skylights Metal Frames Skylights Door Hardware Glazing Louvers & Vents Plaster & Gypsum Board Gypsum Board Tiling Stone Tiling Acoustical Ceilings Specialty Ceilings Vendor Registration Form Date Revised:

5 Flooring Treatment Specialty Flooring Wood Flooring Resilient Flooring Terrazzo Flooring Fluid-Applied Flooring Carpeting Access Flooring Wallcoverings Acoustic Treatment Painting Decorative Finishing High Performance Coating Special Coatings Visual Display Surfaces Signage Post and Panel/Pylon Signage Toilet Partition Erection Toilet Compartments Cubicles Operable Partitions Toilet Bath & Laundry Accessories Fireplaces & Stoves Emergency Aid Specialties Fire Protection Specialties Lockers Postal Specialties Storage Assemblies (Racking/Shelving) Wardrobe & Closet Specialties Awnings Car Shelters Flagpoles Pest Control Devices Grilles & Screens Flags & Banners Security Mirrors & Domes Scales Misc. Specialties Vehicle Service Equipment Carwash Parking Control Equipment Loading Dock Equipment Pedestrian Control Equipment Security, Detention & Banking Equip Mercantile & Service Equip. (Store) Commercial Laundry & Dry Cleaning Equip Maintenance Equipment Hospitality Equipment Office Equipment Vendor Registration Form Date Revised: Postal, Pkging & Shipping Equip Residential Equipment Food Service Equipment Library Equipment Audio Visual Equipment Laboratory Equipment Entertainment Equipment Athletic &Recreational Equipment Healthcare Equipment Collection & Disposal Equip. (Solid Waste) Art Window Treatments Casework Countertops Furnishings & Accessories Furniture Interior Planters & Artificial Plants Site Furnishings Swimming Pools Fountains Tubs & Pools (Hot Tub/Whirlpool/Therapeutic) Special Purpose Rooms Cold Storage Rooms Special Activity Rooms (Sauna/Steam) Special Structures Elevators Escalators & Moving Walks Lifts Powered Scaffolding (Window Washing) Facilities Chutes (Escape/Laundry/Trash) Pneumatic Tube Systems Fire Suppression (Sprinkler Systems) Fire Ext. Systems (Clean Agent/Wet-Dry Chemical) Plumbing Plumbing, Piping & Pumps Plumbing Fixtures HVAC HVAC Piping & Pumps Central Cooling Equipment Electrical Systems Medium Voltage Electrical Dist Low Voltage Electrical Dist Electrical Power Generating & Store Equip Lighting

6 Energy Management Communications Data Communications Voice Communications Communications & Monitoring Sys Electronic Safety & Security Earthwork Soil Treatment Rodent/Termite Control Soil Stabilization Shotcrete Soil Slope Stabilization Shoring & Underpinning Caissons Special Foundations Bases, Ballasts & Paving Asphalt Paving Curb and Gutter Paving Specialties (Bumpers & Marking) Fences & Gates Retaining Walls Irrigation Systems Planting & Landscaping Site Utilities Water Utilities Wells Drywells Ponds & Reservoirs (Retention Basins) Electrical Utilities (Site) Guideways & Railways Transportation Signaling & Control Equip Process Integration (Gas, Vapor, Combustion) Material Processing & Handling Equipment Hoists & Cranes Process Gas & Liquid Handling, Purification and Storage Equipment Pollution Control Equipment (Air, Noise, Dust) Industry Specific Mfg. Equipment Vendor Registration Form Date Revised:

7 IMPORTANT TAX DOCUMENT SUBSTITUTE FORM W-9 Request for Taxpayer Identification The Internal Revenue Service Center (IRS) requires that we request your Taxpayer Identification Number (TIN) for information reporting purposes. We are required by law to obtain this information from you when making a reportable payment to you. If you do not provide the following information to us, your payments may be subject to 28% federal income tax backup withholding. Also, if you do not provide us with this information, you may be subject to penalties imposed by the Internal Revenue Service under Section 6723 of the Internal Revenue Code. 1. Taxpayer Name (As shown on your Income Tax Returns): Doing Business As (DBA) (Check will be in Taxpayer s Name as indicated above): 2. Taxpayer Address: 3. Remit To/Billing Address (If different from Taxpayer Address): 4. Taxpayer Identification Number or if Individual/Sole Proprietorship indicate SSN: 5. Taxpayer is the following type of entity (check one): Corporation Partnership Individual/Sole Proprietorship Limited Liability Company Tax Exempt/Government Entity Other: Please Explain CERTIFICATION: Under Penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a US citizen or other US person (defined below). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. Form Completed By: Signature: (Sign Name) Today's Date: Main Phone Number: Main Fax Number: PLEASE NOTE: INFORMATION REPORTED ON ITEMS 1, 2 AND 4 MUST BE CONSISTENT WITH DATA ON FILE WITH THE IRS AND SOCIAL SECURITY ADMINISTRATION.

8 AUTHORIZATION TO RELEASE CREDIT INFORMATION The undersigned does hereby authorize any bank or trade reference with whom I am doing business with to release credit information to Ryan Companies US, Inc for the purpose of completing their subcontractor registration process. Name of Business Street Address City State Zip Signature Print Name & Title

9 SAMPLE BONDING LETTER ALL SURETY 100 Main Street, Chicago, IL April 12, 2016 *Information in bold must appear on bonding letter. Ryan Companies US, Inc. 50 South 10th Street, Ste 300 Minneapolis, MN RE: Acme Construction To Whom It May Concern: It is with great pleasure that I provide this pre-qualification letter to you for the ABC Warehouse project in Minneapolis, Minnesota. Acme Construction has been a valued client of All Surety since Their current bonding limits are 50,000,000 single job/125,000,000 aggregate work program. Current unutilized bonding capacity is 75,000,000. *Anticipated unutilized bonding capacity between Fall 2009 and Fall 2010 is 75,000,000. If Acme Construction were to be awarded this project, All Surety will provide the necessary performance and payment bonds. We feel very confident in the abilities of Acme Construction and recommend them for any project that they wish to undertake. Sincerely, Pat Thompson

10 SAMPLE WORKER S COMPENSATION EXPERIENCE RATE MODIFIER LETTER ALL BONDS AND INSURANCE 100 First Avenue, Chicago, IL April 12, 2016 Ryan Companies US, Inc. 50 South 10th Street, Ste 300 Minneapolis, MN RE: Acme Construction To Whom It May Concern: Please accept this letter as verification that the workers compensation experience modifier for the above is as follows: April 1, April 1, April 1, Please call with any questions. Sincerely, Bob Smith

11 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. PRODUCER (877) Name of Insurance Agency Street Address City, State Zip Fax: (000) ; Phone: (000) INSURED Sample XYZ Company Street Address City, State Zip BLANKET Sample Certificate for Labor & Material Agreement CONTACT NAME: PHONE PRODUCER NAME (A/C No. Ext): (000) FAX (A/C No): (000) ACCRESS: PRODUCER CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Dependable Casualty Insurance Company INSURER B: Dependable Indemnity Company INSURER C: Global Indemnity Company INSURER D: INSURER E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR A B C TYPE OF INSURANCE GENERAL LIABLITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR. GEN L AGGREGATE LIMIT APPLIES PER: POLICY PROJECT LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS UMBRELLA LIAB EXCESS LIAB MADE DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under N DESCRIPTION OF OPERATIONS below ADDL INSR N/A. SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YY) POLICY EXP (MM/DD/YY) ##### 12/01/09 12/01/10 ##### 12/01/09 12/01/10 ##### 12/01/09 12/01/10 ##### 12/01/09 12/01/10 LIMITS EACH OCCURRENCE 2,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) 50,000 MED EXP (Any one person) 5,000 PERSONAL & ADV INJURY 2,000,000 GENERAL AGGREGATE 2,000,000 PRODUCTS-COMP/OP AGG 2,000,000 COMBINED SINGLE LIMIT (Ea accident) 1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE X WC STATU- TORY LIMITS E.L. EACH ACCIDENT E.L. DISEASE EA EMPLOYEE E.L. DISEASE POLICY LIMIT If Necessary If Necessary OCCUR CLAIMS- OTH- ER 500, , ,000 D ##### 12/01/09 12/01/10 Professional Liability: 2,000,000 Each PROFESSIONAL LIABILITY Claim/2,000,000 Aggregate (If Architectural or Retroactive Date: structural services); 1,000,000 Each Claim/1,000,000 Aggregate all other CONTRACTORS POLLUTION design/professional services) Contractors Pollution Liability: 1,000,000 LIABILITY Each Claim/1,000,000 Aggregate (Demolition, Retroactive Date: EIFS or Earthwork scopes of work) DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES Certificate applicable to all projects for which Insured is performing operations for Ryan Companies US, Inc. or its subsidiaries. To the fullest extent permitted by law, Ryan Companies US, Inc., Owner and any other person or party as required by Owner under the General Contract shall be additional insured on a primary and non-contributory basis for general liability, Contractors Pollution Liability policy, and umbrella/excess as per forms CG and CG or their equivalent. Waiver of subrogation applies as respects general liability and workers compensation. If applicable, Professional Liability and/or Contractors Pollution Liability policy shall have a retroactive date not later than the date on which services are first performed. CERTIFICATE HOLDER Ryan Companies US, Inc. Attn: Insurance Coordinator CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) ACORD CORPORATION. All rights reserved

12 As required per written contract. All Locations OR As required per written contract.

13 As required per written contract. All Locations OR As required per written contract.