Become a Subcontractor | American Fence Company

Business Classification

Small Business Large Business Small Disadvantaged Minority Owned Women Owned Historically Underutilized Business State Certified

Bonding

Bonding Company

Agent (name and address)

Phone

Bonding Capacity ($)

Bonding Rate (by award value)

Email

Insurance

Agent (name and address)

Phone

Email

Trade References

Reference 1

Company

Contact

Address

Phone

Fax

Reference 2

Company

Contact

Address

Phone

Fax

Major Projects Completed

Project 1

Project Name

Contracted by

Address

Contract Amount ($)

Date completed

Project 2

Project Name

Contracted by

Address

Contract Amount ($)

Date completed

Other Project Information

Has your organization ever failed to complete any work awarded? If yes, provide details.

Has your organization previously worked for American Fence?

If yes, when and where?

Health & Safety

Include data for your entire organization.

Workers Compensation Experience Modification Rate (EMR) — last 3 years

List Workers Compensation Experience Modification Rate (EMR) for the past three years as determined by the National Council Compensation Insurance (NCCI) or the state of

Year 1

Rate

Year 2

Rate

Year 3

Rate

3-Year Average

OSHA Recordable Incident Data — last 3 years

Year 1Year 2Year 3

Year

A) Fatalities

B) OSHA recordable cases

C) Employee hours worked

D) Incidence rate (B×200,000÷C)

How many OSHA citations have you received in the last three years? Year, Number, $ Amount, Explanation

Drug Testing

Do you have a written drug testing policy?

Do you have a written pre-employment drug/alcohol-screening program?

If no, would you be willing to provide/develop a program?

Safety Practices

Do you have a written safety program?

Will your employees working for American Fence be able to understand and comprehend the English language?

Is an inspection program or system to identify and evaluate work place hazards maintained on an on-going basis?

Do established methods or procedures exist for correcting unsafe or unhealthy conditions in a timely manner?

Is a system in place to communicate with employees about safety and health matters and encourage feedback on safety concerns?

Does an enforcement and disciplinary system exist to ensure that employees comply with company safety and health work practices?

Do you have MSDS’s on site available to employees?

Are all new hires given safety orientation prior to assignment?

If yes, safety orientation includes:

Safe work practices/accident prevention Inspection techniques First aid procedures Accident reporting Emergency procedures Post construction clean-up Hazard communication Fire protection/prevention

Do you conduct and record attendance of the following training?

Lock-Out Tag-Out Power-activated tools Certificate Respiratory Protection Fire Watches Occupational Noise Exposure Portable Fire Extinguisher Haz-Mat Awareness Level

Do you have a written compliance plan for OSHA?

Are all employees, including leased or temporary employees, trained in the practices necessary to perform their jobs safely?

Certification

Applicant understands this confidential information is for evaluating the qualification of contractors only and does not warrant that any work will actually be awarded or that applicant will qualify or be approved for contracting for American Fence Company and/or any subsidiaries. Applicant gives their permission to verify the information stated herein.

Printed Name and Title *

Telephone Number *

Email Address *

I certify that the above information is true and correct to the best of my knowledge and I am an authorized representative of the above named company. *

Subcontractor
Application

Company Information

Business Classification

Bonding

Insurance

Trade References

Major Projects Completed

Health & Safety

Certification

Application received

Contact Our Manufacturing Division

Become a Subcontractor | American Fence Company

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SubcontractorApplication

Company Information

Business Classification

Bonding

Insurance

Trade References

Major Projects Completed

Health & Safety

Certification

Application received

Contact Our Manufacturing Division

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