Port of Woodland

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Port of Woodland Office

Small Works Roster Application

Company Name:
Contact Name:		E-mail:
Street Address:		Web Site:
Mailing Address:		Phone:
City, St, Zip:		Fax:
Type of Ownership:	Corporation LLC Sole Prop. Other

Services Provided: (check all that apply)
Asbestos Removal	Environmental Work	Milwork and Casework
Asphalt Paving	Excavation and Earthwork	Plumbing
Concrete Work	Fire Protection	Railraod Construction/Repair
Data Comm./Computer	General Construction	Remodeling
Demolition	HVAC	Roof Construction and Repair
Dock Work, Piling, and Marine	Insulation and Moisture Protection	Utility Construction
Doors, Frames, and Windows	Landscaping	Electrical
Mechanical	Other:

Name:		Date:
Contactractor License #:		Expiration Date:
Federal Tax ID #:		UBI #:
Woodland Bus. License #:		Empl. Sec. Dept #:
Insurance Agent/Company:
Washington State Law allows the Port to use the Small Works Roster for contracts up to $200,000 or less (including sales tax). Does your company have bonding capacity to this limit? Yes No If not, please state your limit: $
Have you ever worked for the Port? Yes No Port Contact:
List two references: (please provide name and phone number) 1.
2.
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 which may result by submittal of this application.
Before contracting, the Port of Woodland may require additional information such as: statement of qualifications, insurance requirements, performance bond, etc.

Subject:

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