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Registration Form

Please complete the following to the best of your ability. We realize that the information requested may not apply to every subcontractor. If you are a supplier, rather than listing previous experiences on past projects, please provide recent data on projects for which you have supplied material.

Within one business day after submission of registration form you should receive an email indicating the status of your registration. If approved, there will be a link to follow which will allow you to register a password to be used with your username to log onto our site.

If you are not currently prequalified with BEC SW, please complete all the information requested.
The fields highlighted with a red asterisk * are required. 

Company Name*

Specialty*

Contact Person*

Title

Address*

Suite Number

City

State

Zip Code

Fax

 

Username*

Telephone*

Cellular Phone

E-mail *

Dun & Bradstreet
Number*

Contractors License Number*

License Classification

License State

Business Status: (Please check all that apply.)

Small Business (SB)

Large Business (LB)

Small Disadvantaged Business (SDB)

Woman-Owned Small Business (WOSB)

Minority Business Enterprise (MBE)

Veteran-Owned Small Business (VOSB)

Native American Ownership

Service-Disabled Veteran-Owned Small Business (SDVOSB)

Open Shop

Union

Has your company ever

Operated under another name?

Yes No Please list

Filed for bankruptcy?

Yes No  

Has your principals ever

Worked for a company that failed to complete a project?

Yes No  
Number of Employees
Number of Years in Business
Annual Volume: $

Please indicate if your firm is registered with any of the following Small Business Administration (SBA) Programs:

HUBZone Certification Certified Small Disadvantaged Business (SDB) Program
   
8(a) Certification Program – 8(a) Certification #

Is your firm bondable?

Yes No  
Is your firm bondable?
Capacity $ Current Backlog $

Name and Telephone Number of Surety

Does your firm carry General Liability?

Yes No  
Carrier and Contact Information
List limits Each Occurrence General Aggregate

Does your firm carry Worker’s Comp?

Yes No  

Does your firm have a Substance Abuse Program?

Yes No  

Does your firm have a Safety Program?

Yes No  
What is your current EMR (Experience Modification Rating)?

(Multiplier used in Workers Compensation premium calculations to recognize accident experience)