Public Utility District No. 1

   Grays Harbor County

        P. O. Box 480

   Aberdeen, WA 98520

 

Date:  _________________

 

SMALL WORKS ROSTER APPLICATION

 

 

  1. COMPANY NAME:  ___________________________________________________________
  2. MAILING ADDRESS:  _________________________________________________________

___________________________________________________________________________

  1. TELEPHONE:  _______________________________________________________________
  2. CELL PHONE: _______________________________________________________________
  3. FAX NO.:  __________________________________________________________________
  4. E-MAIL ADDRESS:  __________________________________________________________
  5. NO. OF YEARS IN BUSINESS:  _________________________________________________
  6. CONTRACTOR’S LICENSE NO.:  _______________________________________________
  7. ACCOUNT NO. UNDER WHICH INDUSTRIAL INSURANCE, MEDICAL AID, ETC. PAYMENTS ARE REPORTED:  _________________________________________________
  8. PLEASE FURNISH A LIST OF REFERENCES, INCLUDING A CONTACT PERSON AND A TELEPHONE NUMBER, FOR WHICH YOU HAVE PERFORMED SIMILAR WORK DURING THE LAST THREE YEARS:

 

 

 

 

 

 

IMPORTANT INFORMATION

 

  1. ALL WORK DONE FOR THE DISTRICTIS DEEMED TO BE “PUBLIC WORKS” PROJECTS.

 

  1. FOR PUBLIC WORKS CONTRACTS, THE CONTRACTOR MAY BE REQUIRED TO PRODUCE A “PUBLIC WORKS CONTRACT PERFORMANCE BOND”.

WHAT IS THE MAXIMUM CONTRACT AMOUNT YOU FEEL YOUR COMPANY WOULD QUALIFY TO PERFORM?  ____________________________________________________

 

  1. PREVAILING WAGES MUST BE PAID ON ALL PUBLIC WORKS, AND AN “INTENT TO PAY PREVAILING WAGES” AND AN “AFFIDAVIT OF WAGES PAID” MUST BE FILED WITH THE DEPARTMENT OF LABOR AND INDUSTRIES ON ALL PROJECTS, AT THE CONTRACTOR’S EXPENSE.

 

  1. A CERTIFICATE OF LIABILITY INSURANCE IN THE AMOUNT OF $2,000,000 MUST BE SUPPLIED FOR EACH PUBLIC WORKSCONTRACT.

 

SMALL WORKS ROSTER CLASSIFICATIONS

 

____________________________________________ requests listing on the Grays Harbor Public

                           (Firm name)                                           

Utility District’s Small Works Roster under the following classifications:

 

_____ Asphalt Paving

_____ Janitorial

_____ Asphalt Hauling

_____ Landscaping

_____ Boring

_____ Lighting

_____ Carpentry

_____ Lowboy Trucking

_____ Communications installation/repair

_____ Microwave radio install/repair/inspection

_____ Communication tower install/repair/inspect

_____ Painting

_____ Concrete work

_____ Plumbing                  

_____ Construction/General Contractors

_____ Road building

_____ Crane work

_____ Rock and rock supplies

_____ Demolition/excavation

_____ Roofing – Metal, installation

_____ Electrical work

_____ Roofing – Other

_____ Environmental concerns

_____ Security and fire systems monitoring

_____ Fencing

_____ Security and surveillance

_____ Fiber optic cable installation/repair

_____ Security system installation

_____ Fiber optic cable splicing and testing

_____ Sheet Metal 

_____ Floor & window covering/installation

_____ Sign installation

_____ Geothermal Heat Pumps

_____ Site preparation

_____ Gutters

_____ Street repairs and construction

_____ HVAC

_____ Telecommunications engineering, inspection

_____ Hauling/gravel, dirt, etc

_____ Telephone system installation/repair

_____ Industrial cleaning

_____ Trenching

_____ Insulation measures

_____ Two-way radio installation/repair

_____ IT programming

_____ Welding/metal fabrication

_____ IT supplies

_____ Window installation

_____ IT system installation/repair

_____ Miscellaneous (list below)

 

           Other Work Classifications Your Company Performs – please list: 

Date:  _________________

 

SMALL WORKS ROSTER APPLICATION

 

 

  1. COMPANY NAME:  ___________________________________________________________
  2. MAILING ADDRESS:  _________________________________________________________

___________________________________________________________________________

  1. TELEPHONE:  _______________________________________________________________
  2. CELL PHONE: _______________________________________________________________
  3. FAX NO.:  __________________________________________________________________
  4. E-MAIL ADDRESS:  __________________________________________________________
  5. NO. OF YEARS IN BUSINESS:  _________________________________________________
  6. CONTRACTOR’S LICENSE NO.:  _______________________________________________
  7. ACCOUNT NO. UNDER WHICH INDUSTRIAL INSURANCE, MEDICAL AID, ETC. PAYMENTS ARE REPORTED:  _________________________________________________
  8. PLEASE FURNISH A LIST OF REFERENCES, INCLUDING A CONTACT PERSON AND A TELEPHONE NUMBER, FOR WHICH YOU HAVE PERFORMED SIMILAR WORK DURING THE LAST THREE YEARS:

 

 

 

 

 

 

IMPORTANT INFORMATION

 

  1. ALL WORK DONE FOR THE DISTRICTIS DEEMED TO BE “PUBLIC WORKS” PROJECTS.

 

  1. FOR PUBLIC WORKS CONTRACTS, THE CONTRACTOR MAY BE REQUIRED TO PRODUCE A “PUBLIC WORKS CONTRACT PERFORMANCE BOND”.

WHAT IS THE MAXIMUM CONTRACT AMOUNT YOU FEEL YOUR COMPANY WOULD QUALIFY TO PERFORM?  ____________________________________________________

 

  1. PREVAILING WAGES MUST BE PAID ON ALL PUBLIC WORKS, AND AN “INTENT TO PAY PREVAILING WAGES” AND AN “AFFIDAVIT OF WAGES PAID” MUST BE FILED WITH THE DEPARTMENT OF LABOR AND INDUSTRIES ON ALL PROJECTS, AT THE CONTRACTOR’S EXPENSE.

 

  1. A CERTIFICATE OF LIABILITY INSURANCE IN THE AMOUNT OF $2,000,000 MUST BE SUPPLIED FOR EACH PUBLIC WORKSCONTRACT.

 

SMALL WORKS ROSTER CLASSIFICATIONS

 

____________________________________________ requests listing on the Grays Harbor Public

                           (Firm name)                                           

Utility District’s Small Works Roster under the following classifications:

 

 

_____ Asphalt Paving

_____ Janitorial

_____ Asphalt Hauling

_____ Landscaping

_____ Boring

_____ Lighting

_____ Carpentry

_____ Lowboy Trucking

_____ Communications installation/repair

_____ Microwave radio install/repair/inspection

_____ Communication tower install/repair/inspect

_____ Painting

_____ Concrete work

_____ Plumbing                  

_____ Construction/General Contractors

_____ Road building

_____ Crane work

_____ Rock and rock supplies

_____ Demolition/excavation

_____ Roofing – Metal, installation

_____ Electrical work

_____ Roofing – Other

_____ Environmental concerns

_____ Security and fire systems monitoring

_____ Fencing

_____ Security and surveillance

_____ Fiber optic cable installation/repair

_____ Security system installation

_____ Fiber optic cable splicing and testing

_____ Sheet Metal 

_____ Floor & window covering/installation

_____ Sign installation

_____ Geothermal Heat Pumps

_____ Site preparation

_____ Gutters

_____ Street repairs and construction

_____ HVAC

_____ Telecommunications engineering, inspection

_____ Hauling/gravel, dirt, etc

_____ Telephone system installation/repair

_____ Industrial cleaning

_____ Trenching

_____ Insulation measures

_____ Two-way radio installation/repair

_____ IT programming

_____ Welding/metal fabrication

_____ IT supplies

_____ Window installation

_____ IT system installation/repair

_____ Miscellaneous (list below)

 

 

           Other Work Classifications Your Company Performs – please list: 

 

 

 

(Form42-9/06)                                                                                                                                                         2014-2016 Application

 

Hours of Operation: Weekdays 8:00-5:00 • PO Box 480 • 2720 Sumner Ave • Aberdeen, WA  98520 • 360-532-4220 • 800-562-7726
 

Our mission: Serve our community with high value utility services at the lowest practical cost.