Application form required to be submitted by vendors who by tqd15644

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									                                                  Maintenance        509-222-5070          Dave Bond, Superintendent
                                                  Purchasing         509-222-5074          Dr. Chuck Lybeck, Associate Superintendent, Curriculum
                                                  Facilities         509-222-6979          Ron Williamson, Assistant Superintendent, Secondary Education
                                                  Transportation     509-222-5075          Greg Fancher, Assistant Superintendent, Elementary Education
                                                  Nutrition Services 509-222-5073          Beverly Johnson-Torelli, Assistant Superintendent, Human Relations
                                                  Fax                509-222-5057          Ron Cone, Executive Director, Information Technology
                                                  622 N. Kellogg                           Lorraine Cooper, Director, Communications and Public Relations
                                                  Kennewick, Wa. 99336                     Vic Roberts, Manager, Business Operations
Education… the Bridge to the Future

                                         Please fill out all fields below. Incomplete applications will not be considered.
  Company:

  Contact:

  Address                                                               City:                               State:                           Zip:

  Telephone:                                                                      Fax:

  E-mail:                                                                         Web Address (if applicable):




  Are you bonded in Washington State?                    Yes                    No           List Bonding limit $

  Name of Insurance Co.                                                           Amount

  Contractors Registration #                                                      UBI #


  References – Municipality or School District Preferred:       List Agency Name, Contact & Phone Number:

       1.


       2.



                                         IMPORTANT: Please indicate areas of interest on the following page.

In our policies and practices we agree to provide equal opportunities for all persons without regard to race, color, religion, national origin,
handicaps, age, marital status, sex, Vietnam-era or disabled veteran status or other extraneous factors.

By signing 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.




Print Name and Title




Signature                                                                                                                       Date


Prior to contracting, the District may require additional information – such as references, statement of qualifications, Insurance requirements, performance
bond, etc. If you wish to provide such information now, please attach the data to this form.
                                                Maintenance        509-222-5070         Dave Bond, Superintendent
                                                Purchasing         509-222-5074         Dr. Chuck Lybeck, Associate Superintendent, Curriculum
                                                Facilities         509-222-6979         Ron Williamson, Assistant Superintendent, Secondary Education
                                                Transportation     509-222-5075         Greg Fancher, Assistant Superintendent, Elementary Education
                                                Nutrition Services 509-222-5073         Beverly Johnson-Torelli, Assistant Superintendent, Human Relations
                                                Fax                509-222-5057         Ron Cone, Executive Director, Information Technology
                                                622 N. Kellogg                          Lorraine Cooper, Director, Communications and Public Relations
Education… the Bridge to the Future             Kennewick, Wa. 99336                    Vic Roberts, Manager, Business Operations


                                      THIS APPLICATION WILL BE KEPT ON FILE UNTIL AUGUST 31, 2010

       alarm systems ( fire & security)                                                 irrigation installation
       asbestos/lead abatement                                                          maintenance (window washing, carpet cleaning)
       asphalt paving                                                                   masonry
       asphalt patching                                                                 metal fabrication
       carpentry/remodeling                                                             painting
       concrete – curb, gutter and sidewalk                                             playground equipment/bleachers
       concrete – retaining walls, foundations, flat work                               plumbing
       data/telecom installation                                                        pest control
       court surfacing                                                                  portable moving
       demolition                                                                       pressure washing
       earthwork                                                                        roofing
       electrical (commercial)                                                          sewer storm drains
       elevator service                                                                 sidewalk repair
       environmental work                                                               signage
       fencing                                                                          sports fields
       flooring                                                                         sprinkler systems (fire)
       general building construction                                                    stage equipment
       grading                                                                          traffic, parking & pavement markings
       grounds maintenance (including tree service)                                     underground storage tank removal
       hazardous materials clean up                                                     underground utilities
       HVAC                                                                             waterproofing
       hydro seeding                                                                    windows and glazing
       HVAC                                                                             waterproofing
       hydro seeding                                                                    windows and glazing

       Other (Please specify):




  All work performed for Kennewick Public Schools must be executed in compliance with Chapter 39.12 RCW, The Washington State Public Works Act,
  also known as the Prevailing Wage Law.
  By signing this application, I certify compliance with the above requirements. Additionally, if awarded a small works job, I agree to provide a Certificate
  of Insurance and the District has the right to retain 5% of the payment pending appropriate agency releases. Further, I understand, the District is under no
  obligation to actually award work based on this application and the District has the right to remove this application from the small works roster at any time



  (District Use Only)

								
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