NOTICE OF PUBLIC WORKS

SMALL WORKS CONTRACTOR ROSTER

Town of Fairfield, Town of Latah, Town of Rockford,Town of Waverly, City of Tekoa

The Town of Fairfield, the Town of Latah, the Town of Rockford, the Town of Waverly, and the City of Tekoa is accepting contractors for the Small Works Roster. Small works contracts are projects of which the estimated cost of construction is less than $300,000.00.

Please complete information on this form and return to the City of Tekoa, P.O. Box 927, Tekoa WA 99033. Fax: 509-284-3590 Email: .

PRE-QUALIFICATION REQUIREMENTS

Firms on the Small Works Roster must be able to provide the following items. Number one, two and three must accompany application to be added to our roster.

  1. List of references of similar projects performed by contractor.
  1. Copy of contractor license.
  1. Statement that contractor has no previous record of default in the performance of, and/or failure to complete a written public contract and has not been convicted of a crime arising from a previous public contract.
  1. Insurance, naming the city/town as additional insured, prior to performance of any contract.
  1. Performance bond prior to performance of any contract more than $2,500 including sales tax.

For contracts between $2,500 and $35,000 the contractor may opt for 50% retainage to be paid 30 days after date of final acceptance in lieu of performance bond.

  1. Contractor shall file Intent to Pay Prevailing Wages and Affidavit of Wages paid with the Department of Labor and Industry.

For contracts less than $2,500 including tax, a Small Works Public Works Contract may be filed with the City of Tekoa with prior approval from city/town.

This institution is an Equal Opportunity Provider.

SMALL WORKS CONTRACTOR ROSTER

APPLICATION

Town of Fairfield, Town of Latah, Town of Rockford, Town of Waverly, City of Tekoa

COMPANY NAME______

MAILING ADDRESS ______

STREET ADDRESS______

CITY/STATE______ZIP______

TELEPHONE ( ) ______CELL( )______EMAIL______

BANKING REFERENCE Name of Bank______

Address______

TYPE OF OWNERSHIP (circle one) PartnershipCorporationSole Proprietorship# OF EMPLOYEES______

CONTRACTOR LICENSE #______WASHINGTON UBI#______

EMPLOYER IDENTIFICATION #______EMPLOYMENT SECURITY DEPARTMENT #______

INDUSTRIAL INSURANCE #______Is your industrial insurance current?______

Circle the item (s) that best describes type of contract your firm qualifies to perform:

Concrete Placement/FinishingPlumbing

ElectricalRoofing

General ConstructionStorm Drainage

HeatingSewerage System

MasonryStreet Repair

PaintingTraffic Signalization

PavingWater Systems

Other______

(Specify)

By signature below, I acknowledge that I have read and understand the requirements described in this application, and to the best of my knowledge, information provided is a true representation of the named firm’s ability to perform any contracts that may result by submittal of this application.

______

Name & TitleSignature