Company name*

First name

Last name

Phone

Email*

Position

Trade / Scope of Work

Crew Size / Employees

WCM Clearance Letter (Y/N)

WCB / Work Safe Account Number (Y/N)

Insurance Expiry Date (Y / N)

COR Certification (Y / N)

First Aid Certified Personnel (Y / N)

Emergency Procedures Provided (Y / N)

Payment Terms (Net 30/45/60)*

Unit Rates (Drywall, Tape, Paint, ACT)

Hourly Rates

Lead Time / Availability

W9*

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Background Check*

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General Liability *

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AUTO*

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W.C.*

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UMB*

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Jurisdiction - Professional License *

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References Attached

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