RENEWAL APPLICATION

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					                                     RENEWAL APPLICATION
Company Name: ________________________________________________________________
Street Address: _________________________________________________________________
City/State/Zip: __________________________________________________________________
   Mailing Address (if different from above): ________________________________________
   City/State/Zip: ______________________________________________________________
Telephone: ____________________________ Fax:___________________________________
Web Site Address: ______________________________________________________________
Executive Representative to RCA: __________________________________________________
Job Title: ______________________________________________________________________
Email: ________________________________________________________________________
Number of Employees: ___________________________________________________________


                             OPTIONAL CONTACT INFORMATION
   Providing the following information will help RCA tailor its messages to the appropriate company contacts.

Assistant to the Executive Representative (to be cc’ed on RCA member email correspondence):
Name: _____________________________________Phone: ________________________
Email: ___________________________________________________________________

Director of Marketing (or equivalent):
Name: _____________________________________Phone: ________________________
Email: ___________________________________________________________________
Safety Program contact:
Name: _____________________________________Phone: ________________________
Email: ___________________________________________________________________

                                        MY BUSINESS IS/HAS:
                                        Include a copy of documentation.
____Minority Owned Business (MBE)                    Certificate number _________________
____Women Owned Business Enterprise (WBE)            Certificate number _________________
____LEED Accredited Professional
                      Name of Certificant_________________________________________
____Certified Development Design & Construction Professional
                      Name of Certificant_________________________________________


                                             OUR WORK IS:
                                              Check all that apply.
____Department Stores            ____ Grocery Stores                          ____Restaurants
____Retail Big Box               ____Retail Tenant Improvement                ____Shopping Center
400 North Washington Street #300, Alexandria, VA 22314 P: 800-847-5085/703-683-5637 F: 703-683-0018
                                                       LICENSES
  Provide the license/registration numbers and expiration dates for the states in which you operate. Include a copy of each.

                                                                           State Contractor
 State               State                 Contractor License                   Expires
                                                                             Registration   Operate (Y/N)
 AL             Alabama
 AR             Arkansas
 AK              Alaska
 AZ              Arizona
 CA            California
 CT           Connecticut
 CO             Colorado
 DC       District of Columbia
 DE             Delaware
 FL              Florida
 GA              Georgia
 HI              Hawaii
 ID               Idaho
 IL              Illinois
 IN              Indiana
 IA                Iowa
 KS              Kansas
 KY             Kentucky
 LA             Louisiana
 ME               Maine
 MD             Maryland
 MA          Massachusetts
 MI             Michigan
 MN            Minnesota
 MS            Mississippi
 MO             Missouri
 MT             Montana
 NE             Nebraska
 NJ           New Jersey
 NH         New Hampshire
 NV              Nevada
 NM           New Mexico
 NC         North Carolina
 ND          North Dakota
 NY            New York
 OH                Ohio
 OK            Oklahoma
 OR              Oregon
 PA          Pennsylvania
 RI          Rhode Island
 SC         South Carolina
 SD          South Dakota
 TN            Tennessee
 TX               Texas
 UT                Utah
 VT             Vermont
 VA              Virginia
 WA           Washington
 WI            Wisconsin
 WV          West Virginia
 WY             Wyoming
 PR           Puerto Rico
 VI          Virgin Islands
                  Guam
400 North Washington Street #300, Alexandria, VA 22314 P: 800-847-5085/703-683-5637 F: 703-683-0018
                                                     CANADIAN LICENSES
       Provide the license/registration numbers and expiration dates for the provinces in which you operate. Include a copy of each.

                                                                                Province Contractor
Province               Province                   Contractor License               Registration              Expires        Operate (Y/N)
  AB                Alberta
  BC           British Columbia
  MB               Manitoba
  NB            New Brunswick
  NL       Newfoundland and Labrador
  NS             Nova Scotia
  ON                Ontario
  PE         Prince Edward Island
  QC                Quebec
  SK             Saskatchewan




       400 North Washington Street #300, Alexandria, VA 22314 P: 800-847-5085/703-683-5637 F: 703-683-0018
                                     RENEWAL CHECKLIST

Please provide the following items with your application. Incomplete applications will be
returned, to be resubmitted when complete.

      Completed Membership Application.

      Copy of your Insurance Certificate showing General Liability and Workers Compensation
       coverage.

      Letter from your bonding company indicating that they will provide Performance and Material
       Payment Bonds for your projects. Bonding company must be AM Best rated A- or better.

      License/registration information as outlined on page two of this application. Copies of all licenses
       and registrations.

      A completed AIA Document, A305-Contractors Qualification Statement, addressed to RCA
       (inclusion of a financial statement is optional).

      Dues are $1,500.00 per year payable by May 31. Checks should be made payable to:
                    Retail Contractors Association
                    400 North Washington Street, Suite 300
                    Alexandria, VA 22314


   WE ARE INTERESTED IN LEARNING MORE ABOUT THE FOLLOWING RCA
                           PROGRAM(S):
____ RCA Safety Program
____ RCA Quality Assurance Program
____ RCA Career Development/Education

       WE ARE INTERESTED IN LEARNING MORE ABOUT THE FOLLOWING
                             COMMITTEES:

____ Career Development/Education                        ____ Scholarship
____ Marketing/Advertising                               ____ Sponsorship
____ Membership                                          ____ Trade Shows & Conferences
____ Safety                                              ____ Quality Assurance




400 North Washington Street #300, Alexandria, VA 22314 P: 800-847-5085/703-683-5637 F: 703-683-0018
                                         MEMBERSHIP REQUIREMENTS
In order to be eligible for membership into the Association, an individual, partnership, firm, or corporation must meet and
maintain the following qualifications in the sole discretion of the Association’s Board of Directors:

     1.   A member must be engaged directly in Retail construction; as a general contractor.

     2.   A member must have been directly related in retail construction for the last five years as a general contractor at the time
          of application membership.

     3.   A member agrees to comply with and abide by the Association’s Bylaws.

     4.   A member must comply with the Association’s Code of Ethics as follows:

               a.        A member shall retain full regard to the public interest in fulfilling his or her professional
                         responsibilities.

               b.        A member shall not engage in any deceptive practice, or in any practice that creates an unfair advantage
                         for the member or another.

               c.        A member shall not maliciously or recklessly injure, or attempt to injure the professional reputation of
                         others.

               d.        A member shall insure that when providing a service that includes advice, such advice shall be fair and
                         unbiased.

               e.        A member shall not divulge to any person, firm, or company, information of a confidential nature
                         acquired during the course of professional activities.

               f.        A member shall carry out his or her responsibilities in accordance with current professional practice.

               g.        A member shall keep informed of new concepts and developments in the construction process
                         appropriate to the type and level of his or her responsibilities.

               Code of Ethics adopted with permission from the American Institute of Constructors; April 1999 Revision

By signing this Membership Application the applicant represents that the above information is true and correct and that it
currently meets and will continue to meet the Association’s qualifications for membership.


Executive Representative Signature: __________________________________________ Date: ___________________________

Printed Name: __________________________________________ Title: _______________________

Application reviewed:                     Accepted________                Date______
                                                                                                                         Revised 03/2011




400 North Washington Street #300, Alexandria, VA 22314 P: 800-847-5085/703-683-5637 F: 703-683-0018
                                     RCA Scholarship Fund:
                                  A Program Worth Supporting
  The RCA Scholarship Fund is our association’s signature program which aims to give back to
  the retail construction community.

  Each year, RCA awards scholarships to 18 universities across the country, in addition to an
  Internship Scholarship to an intern at a RCA member company. For companies that want to
  give something back to the construction industry, this offers an excellent opportunity to give to
  a worthwhile cause where 100% of the contribution goes to those for whom the giving is
  intended.

  The RCA Scholarship Program would not be possible without the support of RCA members.
  We ask you to consider enclosing a contribution to the Scholarship fund with your membership
  dues renewal payment. Please complete the form below and attach a separate check made
  payable to the RCA Scholarship Fund. Again, thank you for your support!
  
                          RCA Scholarship Fund Contribution Form
I would like to help improve scholarship possibilities for America's top construction management students at 18
                                   universities throughout the United States.

 $100_______        $500_______       $750 _______ $1000_______ $1500 _______                    Other $ _______
                                              Make checks* payable to:

                                              RCA – Scholarship Fund
                                         400 N. Washington Street, Suite 300
                                                Alexandria, VA 22314

                     *PLEASE do not combine your contribution and dues payments in one check.

      Name of Donor:

      Address:




                                                 Want to do more?
                  Please call the RCA office at 800-847-5085 or e-mail info@retailcontractors.org
                             to learn the many ways you can make a difference.

                       All donors will be recognized in the RCA newsletter and on the website.
      400 North Washington Street #300, Alexandria, VA 22314 P: 800-847-5085/703-683-5637 F: 703-683-0018

				
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