Small Works Roster

Grant County Port District No. 8

PO Box 841 Warden WA 98857

2017 Small Works Roster Application

portofwarden@ifiber.tv

509-349-2480

Pursuant to RCW 53.05.12 and 39.04.155, Contractors wishing to be considered by the Port District No. 8 of Grant County, Washington for signature as a prequalified bidder under the Small Works Roster are required to complete the following application and to submit all information as may be required in support thereof.

      1. Name of Applicant:_________________________________________
      2. Address of Applicant:  ________________________________
      3.  Business:________________________________________
      4.   Attach a list of clients served over the last three (3) years including their names,   addresses and location of jobs.
      5.     Number of Years applicant has been in business _____________________________________________
      6.     Check Appropriate:   ( ) Incorporated ( ) Partnership ( ) Sole Proprietorship, Incorporated, state resident agent and address. If Partnership or Sole Proprietorship  state managing person and address.                                                                                                                                                                                                                                                                                                Name: _________________________________                                              Mailing
      7. Address:__________________________________________                                                                                                                                                                                                  .    Federal Tax Identification Number ____________________________________
      8.  ATTACH A COPY OF CONTRACTOR’S CURRENT WASHINGTON STATE   CONTRACTORS’S LICENSE.
      9.  Phone Number (     ) ________________
      10. Fax Number (     ) __________________

Attach a general resume setting forth applicant’s experience, technical qualifications and organizational ability to perform the types of work for which you are seeking prequalification.  This resume shall also include a list of your supervisory personnel,  and their qualifications and years of experience, a list of the number and type of  craftsmen available and a list of equipment available for work.                                                                                                                                                                                                                                                                         Application Signed By:

________________________________

Title: ____________________________

Date: ___________________________

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