General Company Information State:

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1 Vendor Registration Form The purpose of the Regional Connector Constructor s (RCC) registration process is to ascertain if your firm possesses the necessary experience, financial resources, and commitment to safety and quality to perform on our projects. By working with only the most qualified companies, RCC can ensure that we deliver a high level of service to our client. All firms seeking to do business with RCC shall enter and submit company information. Registration information will be stored in RCC s database of firms. Upon review, your company may be considered for this project. Please note that due to the unique nature of this project, final decisions are at the discretion of the RCC project team. Are you renewing a previous RCC registration? check box if "yes Federal ID Number: check box if "no" Full legal name of your firm: If you are operating under a DBA name, please provide the name: First Name: Last Name: Address: First Name: Last Name: Address: Company Address: Primary Contact Information Business Phone: Mobile Phone: Fax: Secondary Contact Information Business Phone: Mobile Phone: Fax: General Company Information State: Zip: City: Country/Region: Years in Business: Firm Experience Contractor/Professional License Number: What Annual Dollar Volume Can Firm Support? : Type of Business: Page 1 of 5

2 Firm Website: We do Business in these Regions: Please provide a brief narrative about firm's business specialty: Please provide the relative North American Industry Classification System (NAICS) Codes for your Firm: NAICS #1: NAICS #2: NAICS #3: NAICS #4: NAICS #5: NAICS #6: Has your firm done work for Skanska in the past? If YES, Please provide brief project information for those projects that you have work with us: To submit additional information, please attach documents to this form. Certifications and Registrations Does your firm hold any of the following registrations? (select all that apply) Disadvantaged Business Enterprise Disabled Veteran-Owner Business Enterprise Minority-Owned Business Enterprise Small Business Enterprise Woman-Owned Business Enterprise HUB Zone Other Certifications If you selected any of the registrations, attach copies of these registrations to this form. Page 2 of 5

3 Labor Resource Information All work shall be performed in accordance with labor provisions according to the project Prime Contract. Salaried Employees: Number of Personnel Employed by the Firm Union/Craft Employees: Percentage of Work Performed by Firm s Own Labor Force: Additional Labor Resource Information Labor Force Characteristics: Bonding and Insurance Information All Subcontractors and Vendors are expected to maintain appropriate levels of bonding and insurance according to the contract requirements. Firm Bonding If your firm is not bondable, please indicate "0" for the bonding rate, per-project bonding capacity, and annual aggregate bonding capacity. Bonding Rate: Per-Project Bonding Capacity: Annual Aggregate Bonding Capacity: General Liability: Automobile Liability: Firm s Aggregate Insurance Policy Limits Workers Compensation/Employer s Liability: Excess/Umbrella Liability: Additional Policies: Attach your firm s current insurance certificates to this form. Safety Information Subcontractors, Consultants and Suppliers shall comply with the project safety policy for all work activities. Does your firm have a documented safety program?: Does your firm conduct and document regular project safety inspections?: Our Safety Meetings include the following parties (select all that apply): check box if yes Craft Employees Salaried Employees Subcontractors Third Parties Page 3 of 5

4 Our New Hire Safety Orientation Program includes (select all that apply): Accident Prevention Emergency Procedures Fire Protection and Prevention First Aid Safe Work Practices Safety Supervision Supervisor s Responsibility Task Specific Training Our Substance Abuse Program testing includes (select all that apply): Toolbox Meetings Random Testing Reasonable Cause Testing Pre Employment Testing Post Accident Testing Return to Duty Testing Worker s Compensation Experience Modification Rate (EMR) Data Years: EMR for past 3 years: Injury and Illness Data Number of Lost Workday Cases: Number of Restricted Workday Cases: Number of Cases with Medical Attention Only: Number of Fatalities: Total Employee Man Hours Worked: Number of Lost Workday Cases: Number of Restricted Workday Cases: Attach copies of your firms OSHA 300A forms for the past 3 years to this form. Page 4 of 5

5 Registration Certification and Acknowledgement All Subcontractors and Vendors are expected to maintain appropriate levels of insurance according to their scope of work. I have reviewed and agree with RCC S Insurance Requirements. RCC takes pride in being among the industry leaders in construction safety performance. RCC recognized that safety is a group effort; all Subcontractors, Consultants and Suppliers shall comply with the project safety policy for all work activities. I have reviewed and agree with Skanska's Safety Expectations. Please review the appropriate contract agreement. I have read and agree with RCC's Contract language. check box if "yes with exceptions Attach exceptions to the section below. RCC does not agree to any exceptions unless signed by a Skanska VP. Decisions regarding award are based upon best value taking into consideration quality, price, contractual risk, and other factors. Registration Attachments Please include any related project attachments here. Submit attachments as individual PDF files clearly identifying each attachment. Attachments include but are not limited to: Exceptions to contract terms and conditions Project experience examples OSHA 300A Forms for the past 3 years Insurance certificates Special registrations including Disadvantages Business registrations I certify all information is true and correct to the best of my knowledge. By typing my name below, I am verifying that I am legally authorized to bind company to a Contract Authorized Representative: Page 5 of 5