Independent Contractor Registration Form and Questionnaire

Transcription

1 Independent Cntractr Registratin Frm and Questinnaire PLEASE COMPLETE THIS REGISTRATION FORM AND ATTACHED QUESTIONNAIRE. YOU MUST SUBMIT ALL REQUIRED ITEMS LISTED BELOW VIA TO: YOU MUST ALSO SEND THE ORIGINAL SIGNED DOCUMENTS TO OUR ADDRESS BELOW WHEN REQUESTED Cmpany Name: Primary Cntact Name: Title Officer/Business Manager Name: Title FEIN (Emplyer Identificatin Number): Street Address: City: _Cunty: State: Zip Cde: Tel: Cell: Fax: E Mail: ASPEN GROVE ABC # (If Any): Type f Organizatin: **This must match yur W-9 IRS Dcument** Sle Prprietr/Individual Crpratin, Partnership, LLC (Limited Liability Cmpany) Other (please specify) REGISTRATION REQUIREMENTS: PLEASE PROVIDE THE FOLLOWING ATTACHMENTS: *COMPANY NAMES MUST MATCH ALL DOCUMENTATION PROVIDED; 1. A Cmpleted Independent Cntractrs Registratin Frm and Questinnaire 2. Cpies f any prfessinal licenses currently held A license is required fr LBP/Envirnmental, Rfing, WDO/Termite Cntractrs, Appraisers, and any ther trade when required by Federal, State r Lcal regulatins. 3. Certificates f Insurance (General Liability, Prfessinal Liability/Errrs and Omissins, Aut Insurance and Wrker s Cmpensatin, Wrkers Cmpensatin State Exemptin/r Wrkers Cmpensatin Waiver) All insurances, Exemptins r Wrkers Cmpensatin Waiver as it applies t yur cmpany business type (preservatin cntractr WDO/Pest Termite Cntractr, Envirnmental, etc.) and its business requirements. A cpy r evidence f insurance is needed fr Phase One f the apprval prcess. Please nte that nce Strategic Alliance Management JV, LLC ntifies yur cmpany that yur cmpany is apprved and wrk rders are ready t be issued, yur cmpany must name Strategic Alliance Management JV, LLC as an Additinal Insured and/r as a Certificate Hlder befre the cmpany can have wrk rders issued t yur cmpany and becme a vendr fr Strategic Alliance Management JV, LLC *ADDITIONAL INSURED/CERTIFICATE HOLDER INFORMATION: (MUST BE ON THE CERTIFICATE EXACTLY AS SHOWN BELOW) Strategic Alliance Management JV, LLC 8095 NW 12 TH ST, Suite 400 Dral, FLORIDA ATT: VENDOR MANAGEMENT DEPARTMENT ***Please nte that nce yur cmpany has been apprved sme r all f the fllwing additinal frms will be sent t yur cmpany t cmplete Phase Tw f the vendr prcess*** W-9 Frm Sub-Cntractrs Agreement Aspen Grve ABC Number(s) [See Page 5 f 5] Submissin f All Original dcuments Page 1 f 5 SAM JV VendRegQ ver /27/2017

2 Independent Cntractr Registratin Frm and Questinnaire T prperly evaluate yur cmpany please cmplete the fllwing sectins: Services prvided: (Check all that apply) QC Inspectins Trash Out/ Cleaning Service HPIR HUD Prperty Inspectin Reprt Initial Cleaning Services Winterize / De winterize Lawn Services Pl Service Lck Changes/Securing Services Rf Inspectins* Rf Repairs* Rf Replacement* WDO Inspectin* WDO Treatment* Mld Remediatin* Mld Disclratin Remval Septic Inspectin and/r Repair* Pl Cvers General Cntractr* General Repairs Electrician* Plumbing* Carpentry Evictins Cash fr Keys * YOU MUST PROVIDE COPIES OF APPLICABLE LICENSES/CERTIFICATIONS FOR THESE ITEMS ALL LICENSES MUST BE VALID AT TIME OF SUBMITTAL Please list additinal services/skills nt listed abve: Have yu dne any f the fllwing? HPIR HUD PROPERTY INSPECTION REPORT QC-B QUALITY CONTROL BENCHMARK REPORT QC-R QUALITY CONTROL RECURRING REPORT Initial REO Clean-Out PCR PROPERTY CONDITION REPORT ROUTINES CLEANING/INSPECTION/LANDSCAPING LBP LEAD BASED PAINT REPORT Page 2 f 5 SAM JV VendRegQ ver /27/2017

3 Independent Cntractr Registratin Frm and Questinnaire SURVEY RE: CAPACITY NUMBER OF AVAILABLE FIELD WORK CREWS? Have yu dne HUD wrk with any f the fllwing Cmpanies? CHECK ALL THAT APPLY Cmpany HUD M&M III, 3.6, 3.8? P.K. Management Grup, Inc. CperCitiWest A2Z Field Services Inntin Enterprises CWIS, LLC First Prestn Sigma Services D yu have access t the fllwing? High Speed Internet Access / Mbile Bradband Internet Reliable service Digital Camera with Time and Date Stamp Applicatin Micrsft Office (Wrd/Excel) Adbe Acrbat Standard r Prfessinal (NOT ADOBE READER) Reliable Cell Phne Service Desktp/Laptp Cmputer Page 3 f 5 SAM JV VendRegQ ver /27/2017

4 Independent Cntractr Registratin Frm and Questinnaire Please check ff the equipment belw that yur crews are prvided with while n site: YES/NO EQUIPMENT YES/NO EQUIPMENT Digital Camera Laptp Tablet Cell Phne(s) Generatr Lawn Service Equipment Air Cmpressr Screw Guns Brms Mps Cleaning Prducts Other BUSINESS CLASSIFICATION DESIGNATION (we gather this infrmatin fr internal use) CHECK ALL THAT APPLY Small Business Business Classificatin Disadvantaged Business Wman-wned Business SDV (Service Disabled Veteran) HUB-Zne Business 8(a) Cntractr Large Business REFERENCES (List 3 Business References) NAME TELEPHONE NUMBER Page 4 f 5 SAM JV VendRegQ ver /27/2017

5 Independent Cntractr Registratin Frm and Questinnaire ASPEN GROVE BACKGROUND CHECK NUMBERS (Please Attach Additinal Sheet If Necessary) ASPEN GROVE NUMBER(s) NAME(s) EXPIRATION DATE(s) LIST OF SERVICES AREAS Please list belw cunties fr each state yu prvide services, in which yu feel yu can adequately perfrm (We d nt accept partial cunties, cities/twns r zip cdes) STATE ALL COUNTIES? COUNTY COUNTY COUNTY COUNTY CERTIFICATION QUESTION: Are yu r any f yur immediate family members related t r have any affiliatin with any principal r emplyee f either P.K. Management Grup, Inc. r Chinye & Cmpany, PA? If s, please prvide names and explain the relatinship. If the answer is NO, please mark this space as N/A : By signing belw, I certify that the freging infrmatin is true and accurate t the best f my knwledge. I understand that the infrmatin n this registratin frm and the results f the backgrund investigatin will remain cnfidential. I als understand that this is nt an ffer f emplyment. Signature Cmpany Name Print Name and Title Date Page 5 f 5 SAM JV VendRegQ ver /27/2017