Register as a Vendor/Sub-Contractor - K.E.R. Construction Company

Sub-Contractor / Vendor Registration

Fields denoted with an asterisk (*) or

are mandatory.

Company Information

Company Name *

DBA (if applicable)

Type of Business *

Years in Business *

Primary Trade *

License Number(s) & State(s) *

Federal EIN / Tax ID *

Minority / Woman-Owned Business

Union Affiliation (if any)

Business Address

Street Address *

City *

ZIP Code *

State *

Phone Number *

Company Email *

Website

Primary Contact

Name *

Title *

Phone *

Email *

Insurance Information

Do you have General Liability Insurance?

General Liability Insurance Carrier (GLI) *

GLI Policy Number *

GLI Expiration Date *

Do you have Worker's Compensation Insurance?

Worker's Compensation Insurance Carrier (WCI)

WCI Policy Number *

WCI Expiration date *

Are you Worker's Compensation Exempt?

Do you have Auto Liability Insurance?

Auto Liability Insurance Carrier (ALI) *

ALI Policy Number *

ALI Expiration Date *

Bonding Capacity *

Bonding Capacity not available

Surety Company

Surety Company *

Surety Company Address

Contact name

Phone *

Trade Qualifications

Primary scopes of work *

Geographic areas served *

Typical Project Size / Value range *

Safety Officer Name (if applicable)

Experience Modification Rate (EMR) *

I do not know my EMR

Supplier References

You must add a minimum of one (1) and a maximum of three (3) supplier references

Company Name *

Reference name *

Reference Phone *

Reference Email *

Project Name *

General Contractor/Owner References

You must add a minimum of one (1) and a maximum of three (3) general contractor references

Company Name *

Reference name *

Reference Phone *

Reference Email *

Project Name *

Required Documentation

Upload W-9 Form *

Certificate of Insurance

Contractor's License

OSHA / Safety Program

Bonding Letter (if applicable)

Company Brochure or Capability Statement (optional)

Additional Notes / Comments

By sending this request, you agree to K.E.R. Construction's privacy policy in regards to the confidentiality and usage of the data provided. For more information, please see our privacy policy.