Contact Information

* required field

Company Name*

Email*

Phone

Fax

Address

Street Address Address Line 2 City State ZIP Code

Website

Type of Ownership

Other Type of Ownership:

Services

Services Provided

Check all that apply:

Other Service:

Contractor License #

License Expiration

Federal Tax ID #

UBI #

Employment Security Department #

Woodland Business License #

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 no, please state your limit:

Have you ever worked for the Port?

Yes
No

If yes, name of Port contact:

Please list two references:

Name

Reference #1

Phone

Reference #1

Name

Reference #2

Phone

Reference #2

Upload and attach W-9 form:

Accepted file types: pdf, Max. file size: 256 MB.

Need a new form:

Download W-9 form from IRS

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.

Signature*

Type your signature

Date

Comments

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Small Works Roster Application