Company Name: Company Structure: CorporationLimited Liability CompanyPartnershipSole ProprietorshipIndividual Company Type: MBE DBE WBE DDB Section 3 Union Non-Union Edge Company Address: Office Phone: Office Fax: Federal Tax ID#: License's or Certifications: Types of Work: Company Website: Direct Contact Name: Position/Title: Cell Phone: Office Phone: Email Address: Has your company been fined or had jobsite fatalities in the past 3 years? Yes No If yes, please explain: Does your organization have a safety policy? Yes No Does your company enforce a Drug Free Workplace? Yes No Insurance: Professional References: Project History (include current projects):
