Workers Compensation Insurance Cerificate

							Welcome To Freeman Built, LLC Vendor Registration

Our vendor registration process is currently being redefined in order to provide an "All-at once"
registration platform in our system.


Before you begin the registration process, please have the following information available:

          1     Licenses Information
          2     Insurance Information
          3     Legal Information

You should know that your information would be treated with extreme conidentiality, and would not be
shared neither used for any other purpose.

This part of the process consists of 7 Excel worksheets you have to fill with the required information

It is extremely important that you proide us all the information required so the compliance Department can
approve your company as an Freeman Built Vendor. Then, you will be eligible to start receiving work orders.

If you need help during the registration process, please contact us at: newvendor@freemanbuiltreo.com

When you finish this process, please send us an email attaching this form, together with the scans and any
other required documentation. ***Note you must add Freeman Built, LLC on all insurance policies***
Frequently Asked Questions:

Why do you ask for my SSN
The SSN is required to those vendors who are registrering themselves, instead of registering
the company. If you are registering your company, and have already gave us the EIN number,
then you do not need to provide us your SSN

Why do you ask me to establish freeman Built, LLC as the cerificate holder?
Because this is the only way we are notified by the insurance Company if a Vendor cancels its
policy.
How do I set Freeman Built, LLC as the cerificate holder?
You should ask your insurance carrier to issue a policy cerificate with Freeman Built, LLC as
the cerificate holder. They will ask you for Freeman Built, LLC Address, which you will find in
the Insurance spread sheet of this
I do not have workers compensation, what should I do?
If required by applicable Law, you need to get worker's compensation in order to work with us.
 Otherwise you should send an e-mail stating you don't need worker's compensation. If your
 State requires you to fill an exemption form, you must send us a proof of the approved
exemption.
Why do you ask for my driving license?
This is how we confirm our vendor's identity. We require this because we had some problems
in the past with vendors with fake identities.

Does the car insurance cerificate need to have Freeman Built, LLC
as the cerificate holder?
Only if it is a company car. If it is a personal car, then a common cerificate that shows the
coverage limits and the expiration date would work.


Suggestions:
About the scans: Please check all the information shown in the scan is legible.
License: Please know that what we require is the specific working license required,
not a tax recipt
Insurance: The insurance cerificates must have Freeman Built, LLC as the certificate holder.
Please be sure this Requirement is accomplished.
Driving License: Please be sure the expiration date and the picture are shown and legible.
Company Registration
Please, register the following information. * Mandatory fields.

Company info                                              Personal Info

* Company Name:                                           * First Name


* Federal EIN                                             * Last Name



Office Info                                               * SSN

* Office Address
                                                          * Title

* Office Address if different form mailing
                                                          * Phone

* City, State, Zip
                                                           Phone

* Office Phone
                                                           Cell Phone

Fax
                                                          * Email

   Contacted By:

                                                          Web Site
Legal Proceedings

Please, mark with an X the yes/ No Answers.
                                                                                         YES NO
Were you involved in any legal proceedings during the last 5 years?

If Yes Then,
Record Type Case Number        Court     Filing Date Process Status Description




                                                               Yes    No
Are you aware of any Threatened legal proceeding?
If Yes then,
Record Type Description




                                                     Yes No
Have you ever been convicted of a felony?
If Yes then,
Record Type Description




                                                                                  Yes No
Have you or any of your employees ever been an employee of Freeman Built
                                                                                            Yes No
Have you ever faced a lawsuit for negligence, errors or omissions?
Have you ever demonstrated a pattern of practice of defalcation regarding opligations?
Have you ever faced a bankruptcy?
Have you ever been involved in a tax evasion?

Comments
Insurance


Please, Provide the following information regarding you insurances:

General Liability
Insurance carrier
Policy Number
Expiration Date
Limit

Employers Liabillity ( Workmans comp)
Insurance Carrier
Policy Number
Expiration Date
Limit

Automobile Liabillity
Insurance carrier
Policy Number
Expiration Date
Limit


You should know that we demand every policy established above. In order to receive work
orders from Freeman Built, LLC a Vendor must have, at least, the following coverage limits:

For General Liabillity: -Property Damage: $1,000,000.00
                          -Bodily Injured: $1,000,000.00

For Workers Compensation:        $500,000.00

For Automobile Liability:      As required by you state.

You should ask your insurance carrier to provide you with a Certificate of your Insurance
Policy, with Freeman Built, LLC as the Cerificate Holder. Then, provide us a scan of this
certificate.

Here is Freeman Built, LLC address, you will be asked for it by your insurance carrier.
Freeman Built, LLC
202 E. McDowell Rd. Suite 235
Phoenix Arizona 85004

The reason we ask for this cerificate is that this is the only way we will be notified by the
insurance carrier if a vendor cancel it's insurance policy.
Driving License


Please, provide your driving license information.
Make a Scan of your Driver License make sure picture and Expiration Date is readable
License

Name
License Number
Expiration Date
State
Service Definition

Please, mark with an X the checkbox corresponding to the service/product you provide.

Inspector                                                  Negotiator

Certification:                                 Vacant Property Registration
                         Septic Cerification              Code Violations
                         Pool Certification               HOA Invoice
                         Occupancy                        9A Form
Payments:                                                 FHA Cerificate
                       Utilities                          Inspection
                   Restoration of Services                Cash For Keys
Quality Inspections:                                      Trial
                       Repair Assess                      Eviction & Lockout
                       Q&A                                Bundle
Other Works:                                              Bid Repuest
                       Inspection
                       Cash for Keys
                         Trial                             Miscellaneous
                         Eviction & Lockout
                         Bundle                           Trip Charge
                         Bid Request                      Cash for Key Invoice



Real Estate Agent


Contractor

Initial Preservation Work

Securing                                        Board Ups
Rey Key                                         Small Opening
Lock Box                                        Medium Opening
Padlock                                         Large Opening
Slide Bolt                                      Sliding Glass or Double Door
Wood Bracing                                    Single Car garage door
Betal Bracing                                   Double Car Garage Door
Pool Board-UP                                   Over 112 Spuare Feet
Dead Bolt                                       Pool Board up
Slide Door Slider Lock               Security Door with hinges & padlock/hasp
Strap Door
Patio Door
Trash Out                          Winterization
Automobile Removal                 Dry Winterization
Debris Removal                     Radiant Winterization
Hazard Removal                     Steam Winterization
Tire disposal                      Replacing Sump Pump
Mold Removal                       Winterization Re-Check
Jacuzzi Removal                    Wet Winterization
Fence Removal
Appliances                         Yard Maintenance
                                   Initial Grass cut- Less than 5,000 Sq Ft
Cleaning                           Initial Grass cut- 5,000 - 9,999 Sq Ft
Initial Janitorial Service         Initial Grass cut- 10,000- 14,00 Sq Ft
                                   Initial Grass cut- Over 15,000 Sq Ft
Removal of Items                   Re-Cut-Less than 5,000 Sq Ft
Carpet Removal                     Re-Cut- 5,000 - 9,999 Sq Ft
Exterior Structure/ Shed           Re-Cut-10,000- 14,00 Sq Ft
                                   Re-Cut-Over 15,000 Sq Ft
Handyman                           Snow Removal
Appliances                         tree or Shrub trimming
Tiles                              Dead Tree Removal
Exhaust Fan                        Weed Removal
Pool Pump
Smoke Detectors                    Roof Repairs
Vent Covers                        Tile
showerhead                         Asphalt
Sprinkler Valve                    Flat
Carpet Replacment                  Foam
Range oven                         Cedar
Broken Doors                       New Roof
Dry Wall Repair
Fence or Gate Repair               Painting
installing Fans                    Interior
Garage Door                        Exterior
Faucets, Sinks ,Valves & Toilets
Water Heater                       Electrical Work
Water Line                         Complex Electric problems
Bathtup Reglaze
Cabinets & Counter Tops            Plumbing
Carpentry                          Complex Plumbing issues
Minor Plumbing Repairs             Sewer
Minor Electrical Repairs           Gas

Pool Maintenance                   Glass & Window Replacment
Drain,Muck out, Acid Wash,         Mirrors
Refill and Maintain                Broken Windows
Mold Remediation      Flooring
                      Carpet install
A/C Specialist HVAC   Carpet Cleaning
AC unit install       Carpet repairs
AC Maintenance        Tile install
AC Repairs            Tile and Grout Cleaning
Boilers
Furnace               Termite Control
Duck Repairs          Termite Inspection
                      Termite Control
Sign installer
sign installation     Pest Control
                      Pest inspection
                      Pest control
References

Please, State Three (3) Different business references:

Reference 1
Company Name
contact Person
Phone Number
Email
relationship with Reference
Comments
Reference 2
Company Name
contact Person
Phone Number
Email
relationship with Reference
Comments
Reference 3
Company Name
contact Person
Phone Number
Email
relationship with Reference
Comments
Questionnaire

How many years have you been in business?




Do You have employees in payroll? How many?




D0 you have 1099 employees? How many?




How many clients are you currently working for?




How much revenue do you make from your largest client in a single year?
Thank you


You have ended the first part of the registration process.

Please send us an email attaching this form and the scans of the following documents: To
 newvendor@freemanbuiltreo.com
                      1 Working License (Contractor License)
                      2 Insurance Policy Certificate
                      3 Driving License
                      4 W-9 Form

Thank you very much for your time