Qualifications. Sno-isle Libraries seeks only those firms that meet the qualifications below:

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1 Dear Contractor: Sno-Isle Libraries encourages you to apply for the Small Works Roster. We use this Roster to invite contractors to bid on small public work jobs (projects under $200,000). Complete and return the attached application, via fax to or mail to: Sno-Isle Libraries, th Ave NE, Marysville, WA 98271, Attn.: Purchasing Department. Qualifications. Sno-isle Libraries seeks only those firms that meet the qualifications below: Hold a State of Washington contractors license insurance at the time of application and throughout enlistment on the roster; Hold specified insurance at the time of application and throughout enlistment on the roster; Companies have been in business three consecutive years prior to application; Companies have a responsible claims history, strong safety record and strong financial history. Sno-Isle Libraries invites at least three contractors in rotating order to submit quotes. Projects above $35,000 require Performance and Payment Bonds or Retainage. The lowest responsive and responsible bidder is selected. We may also request proof of Insurance. Prevailing wages are required on every project. Costs to file prevailing wage statements with the State of Washington are borne by the Contractor. All prevailing wage forms must be received by the City before invoice payments can be made. Applications that are not accepted shall be discarded by Sno-Isle Libraries. Companies may submit a new application at a later date. You can also access our web page at to download enrollment application. Thank you for your interest. If you have questions, call Sincerely, Sno-Isle Libraries Purchasing Department

2 SMALL WORK ROSTER ENROLLMENT APPLICATION CONSTRUCTION CONTRACTORS Return this application back by mail or fax to: FAX: Sno-Isle Libraries ATTN: Purchasing Department th Ave NE Marysville, WA Company Name: Owner Name: Contact Person: Contact Person s Title: Mailing Address: Physical Address: Office Phone: Contact Person Cell Phone: Contact Person Pager: Fax: Company Web Address: Business Classification (specify date established as appropriate): You do not need to have a formal government certification to check these boxes (Self-designated). Woman Owned Minority Owned Federal Disadvantaged Business Individual: Partnership: Corporation: Washington State Contractor License Number: Note: A State Contractor or Specialty License is a minimum requirement to submit an application. UBI Number: Federal Tax ID or Social Security # L&I License Expiration date (For office use only): Would you like your company to be included on our Emergency Response List? Yes: No: If Yes, Emergency Contact Phone # 2

3 Minimum Qualifications Minimum qualifications must be met. The Purchasing Manager reserves the right to reject at any time, including after an initial inclusion on the Roster, if the applicant is not responsible in the opinion of the Purchasing Manager. Do you have a current valid Contractors license and will you maintain the license while on the Roster? Yes: No: Have you been in business at least 3 years without interruption? Yes: No: Do you have a strong claims history, strong safety record (below 1.0 on the L&I rating), and strong financial history? Yes: No: Does any employee or official of any of the current participating roster agencies have any financial or other interest in your firm, which you know of? Yes: No: Insurance Requirements Applicant must have the following minimum insurance coverage in place at the time of application. General liability insurance of at least $1,000,000 per occurrence; $1,000,000 aggregate, Combined Single Limit (CSL); Automobile liability of at least $1,000,000 per accident CSL; and Ability to name the Public Agency as an Additional Named Insured Do you currently maintain the minimum required insurance coverage? Yes: No: If no, describe any differences to the specified coverage amounts: Are there any current claims that are pending against this insurance policy? Yes: No: Contractor Financial History During the past five years, has the contractor been involved in any: Construction bond forfeiture; Yes: No: Construction litigation; or Yes: No: Claims exceeding ten percent of the contract price? Yes: No: Contractor History Provide dates for the periods within the past ten years that the contractor: Has not been an active contractor: Has not been a licensed contractor: Has been in bankruptcy, reorganization or receivership: Has owner been convicted of a felony? or N/A: or N/A: or NA: or NA: Has the company ever been disqualified by any public agency from participation in public contracts. Yes: or No: If yes, explain: 3

4 Contractor Safety Experience SOLE PROPRIETOR: This section will not apply to sole proprietors. Check box if you are a sole proprietor and skip this section. A sole proprietor is an individual that NEVER has employees working for him or her. List contractor s compensation Experience Modification Rate for the four most recent years. If score is above 1.0, provide explanation. Rates above 1.0 are subject to rejection. This rate is given to you every year from Labor & Industries. Your company receives a multi-page report each year, with these rates indicated. If you don t know this rate, call L&I or check their website at Please use the most recent year s OSHA log to provide the following: Number of lost workday cases: Number of fatalities: Does the contractor conduct project safety inspections? Yes: No: Does the contractor have a written Safety Program? Yes: No: Does the contractor have a safety orientation program for new hires? Yes: No: Does contractor have a safety program for foreman? Yes: No: How frequently do on-site crews hold safety meetings? List 2 jobs performed for a public agency. (This is not required to be on the Small Works Roster list, but please provide these 2 references if you have them). Name of Project #1: Owner s Name and phone: Prime Contractor (if not your firm): Dollar amount of your portion of the work: Month and year project completed: Name of Project #2: Owner s Name and phone: Prime Contractor (if not your firm): Dollar amount of your portion of the work: Month and year project completed: 4

5 I swear under penalty of perjury that the above and attached information is correct, and that there are no known personal and/or organization conflicts of interest, which are prohibited by law: Authorized Company Signature: Date: Purchasing Manager Date: Applications that are rejected will be discarded by Sno-Isle Libraries 5

6 The following identifies your company specialties. Mark any and all services you perform. Provide comments if desired: Demolition: Concrete Sidewalks/Curbs/Gutters/Driveways Property Refuse Removal/Disposal Mud-Jacking Building Demolition Asphalt and Concrete Pavement Building/Structure Moving Asphalt Planing (Grinding) Asphalt Demolition Asphalt Chip Seals Structure Demolition Slurry Seal Hazardous Material Removal/Abatement ADA Detectable Warnings Petroleum Contaminated Soil Removal Rockeries Vegetation: Gravity Block Walls Tree Trimming/Removal Pavement Repair Stump Grinding/Removal Manhole and Valve Adjustments Vegetation Disposal Roadway Construction Vegetation Spraying Thermoplastic Pavement Markings Manual Brush Control Paint Striping Mechanical Brush Control Guardrail Installation Reforestation Street Sweeping Tree Transplanting Raised Pavement Markings Traffic Sign Installation Earthwork: Asphaltic Seal Coating Excavation and Trucking Asphalt Crack Filling Excavation Concrete Retaining Walls Grading Concrete Barrier/Permanent & Temporary Erosion Control Concrete Recycling Dump Truck Hauling Waterproofing/Coating/Sealants Horizontal Boring/Drilling Snow Removal Landslide Repair Trenchless Pipe Installation Water/Treatment: Water Well Drilling Location Underground Facilities Leak Detection Service Well Rehabilitation Watermain Construction Pump Service Work Fire Hydrant Installation Drilled Shafts Water Treatment Systems Drainage: Hot Tapping (Watermain Construction) Hot Tapping (Fire Hydrant Installation) Storm Drainage Construction Electrical/Telephone: Storm Drainage Cleaning Electrical Inspection Sanitary Sewers: Electrical Construction Sanitary Sewer Construction Computer/Telephone Cable Construction Side Service Construction Street Light Installation Street Light Maintenance Temporary Sanitary Sewer Bypass Pumping Traffic Loop Installation Repairing Sanitary Sewers - Internally Telephone Wiring/Installations Sanitary Sewer Television Inspection Traffic Signal Installation Sanitary Sewer Cleaning Traffic Counting Systems Installation Sewer Grouting and Sealing Fiberoptics Sanitary Sewer Dig Up Spot Repairs Instrumentation/Control Panels Low Voltage Electric Hot Tapping (Sewer Taps) UPS System Repair Manhole Rehabilitation Site Improvements: Roadway Work: Wood Metallic, Wire Fencing and Gates 6

7 Chainlink Fencing and Gates Hydraulic Gate Installations Netting Overhead Doors Garage Door Installation Hydroseeding Irrigation Systems Landscaping Power Washing/High Pressure Cleaning Industrial Cleaning and Vacuuming Sign Installation Playground Equipment Installation Tennis Courts Vertical Climbing Walls Underground Storage Tank (UST) Installation/Removal/Retrofit Rip Rap Toilet Construction/Access Turf Renovation Buildings Metal Pole Athletic Surfacing Systems Playfield Lighting Installation Machinery Moving/Installation Operated Equipment Rental Fiberglass Railing Systems Docks, Bridges, Piling, Wharfs and Floats Diving Services Sports Turf Drainage Bridge Debris Removal Concrete Masonry: Coring/Drilling Restoration and Cleaning Concrete Cutting/Concrete Sacking Masonry Construction Pre-Cast Concrete Wheel Stops Concrete/Asphalt Wheelchair Ramps/Grab Rails Mechanical: Victaulic, Flanged, Mechanical Joint Pipe Pump Installation Incinerator/Boiler Installation Pipe Sacking Pump Construction Remodel Natural Gas Install & Repair Hot Tapping (Victaulic, Flanged) Vehicle Exhaust Extraction System Solid Waste Compactor Repair/Mntce Facility Construction: Rough Carpentry Finish Carpentry Plumbing HVAC Installation/Controls HVAC Testing and Balancing HVAC Cleaning Insulating Wallboard Installation Fire Sprinkling Systems Floor Covering Hardwood Floor Refinishing Tile/Grout Installation & Repair Windows and Glazing General Building Contracting Metal Fabrication Roofing Painting Concrete Flatwork Security System Installation Sound System Installation Prefab Metal Structures Welding Pedestrian Doors/Automatic or Manual Acoustical Ceiling Cleaning Hot Tapping (Flow Meter Install) Hot Tapping (Fire Sprinkler Systems) Swimming Pool, Spa, Filters, Chemicals Elevator Repair Gutters/Downspouts Water Damage Clean-Up Fire Damage Cleanup Installation of Food Service Equipment Water Tank Exterior/Interior Paint & Wash Hoist and Crane Service Laundry Room Hook-Up/Drain Repair Pest Control Disaster Restoration Generators Furniture Moving Graffiti Removal Revised 8/30/2010 7

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