Building Subcontractor Information

Name of Business___________________________________________________________

Mailing Address____________________________________________________________

_______________________________________________________________________

Phone____________________Cell_______________Pager_______________________

Fax__________________ Email_____________________________________________

Sole Proprietor?_______ Partner?_________Corporation?________________

Name of Owner,
Partners, Corporate Officers:__________________________________________________

________________________________________________________________

Date Business Began___________ Type of Construction_____________________________

Federal Tax ID#: Sole Prop___________________ Partnership________________________

Corporation______________________________

Construction Contractors Board#__________________ Expiration Date_________________

Bonding Company_______________________________ Expiration Date_______________

Worker's Comp Insurance (SAIF or Other)________________________________________

Policy #________________________________________ Expiration Date_____________

General Liability Insurance Company_____________________________________________

Policy#________________________________________ Expiration Date______________

Signature_________________________________________ Date___________________

We must have the items list below in our office before a check will be issued.
•This form, completed and signed
•Photocopy of construction contractors board license
•Certification of insurance issued by worker's compensation carrier
•Certification of insurance issued by general liability carrier