Small Works Roster

In compliance with RCW 28A.335.190, the undersigned requests to be added to the Small Works Roster of Puyallup School District No. 3 and wishes to have the opportunity to submit proposals for the type of work and size of projects as indicated. It is understood that a "no response" to three (3) successive requests for proposals may result in removal from the roster. A written "no bid" response shall not be considered as a "no response".

Company Name

Mailing Address

Physical Address

Email Address

Office Telephone Number

Cell Phone Number

Request for quotation should be directed to:

Namerequired

First Name

Last Name

Title

Type of Organizationrequired

Sole Proprietor

Partnership

Corporation

Date Formed

Must contain a date in M/D/YYYY format

State

Is your firm licensed by the State of Washington under provisions of RCW 18.27?required

Yes

No

Contractor's License No.required

UBI Numberrequired

Expiration Date

Must contain a date in M/D/YYYY format

Is your firm a member of a purchasing cooperative? (ex. KCDA, National IPA, NJPA, BuyBoard)

Yes

No

If so, please list:

List Affiliated Companies:

IN ORDER THAT WE MAY PROPERLY EVALUATE YOUR FACILITIES FOR SUBCONTRACTING PURPOSES, IT IS REQUESTED THAT THE FOLLOWING QUESTIONS BE ANSWERED IN FULL.

1. List principals -- (owner[s], partners, and corporate officials):

(Name), (Title)

Bank(s):

Other type of work:

List principal companies for whom work is performed:

(Company), (Address)

List previous work experience, if any, with other school districts or state agencies. [Include: Name and address of client, name and telephone number of contact person, approximate dollar value, dates of work, and a description of the work performed.]required

Name & Address of Client Name & Telephone Number of Contact Approx. Dollar Value, Dates Description

SMALL BUSINESS CERTIFICATE: “A Small Business is a concern, including its affiliates, which is independently owned and operated, is not dominant in the field of operation in which it is bidding, and can further qualify under the criteria established by the Small Business Administration.”

Vendor Certifies required

it is

is not a small business concern

Total Number of Employees

Union Affiliations

Will you provide performance/payment bond, affidavit of intent to pay prevailing wagesand insurance certificates for work to be performed when required by the District?required

Yes

No

Puyallup School District No. 3 is an equal opportunity and affirmative action employer andthe provisions of Executive Order 11246, dated September 24, 1965, as amended, willapply to any work performed by you for Puyallup School District No. 3. Do you comply with these requirements?required

Yes

No

Are you registered with the State of Washington as a minority or woman-owned business?required

Yes

No

What are the limits of your general liability insurance?(minimum limit $1,000,000)required

What are the limits of your auto liability insurance?(minimum limit $1,000,000)required

Project size for which you wish to receive requests for proposals:required

$0 - $ 15,000

$15,001 - $ 50,000

$50,001 - $350,000

Brief history of company:

Company Authorizationrequired

First Name

Last Name

Title

Today's Daterequired

Must contain a date in M/D/YYYY format

I am authorized to submit on behalf of the company identified.required

Yes

Popular Pages

Sticky Right Buttons

Landing Nav

In This Section

Overview

Small Works Roster Request Form

Questions? Contact Us

Contact Info

Quicklinks