Subcontractor Prequalification

Form W-9

Thank you for your interest in working with Philadelphia Sign. To get started, we need your W-9 form uploaded. If you do not have one, please visit the IRS website here to download a copy to fill out.

Company

Contact Information

Contact Name
Phone
Fax
Cell
Email

Licenses and certifications

Does your company have a contractor's license?

YesNo

What area does it cover? (List specific city, county, and/or state)
Do you have any additional licenses(master electrician license, electrical contractor’slicense, other)?YesNo
What welding certifications, if any, are held by your company?

NOTE: You will need to provide a copy of the welding certification for each certified employee. You will also need to provide copies of all licenses for all individual employees and for all governing entities. Attach a separate page if there are multiple licenses to be listed.

Photos and Documentation

PSCO requires photos and documentation of your previous work for review prior to approval as our vendor. Provide the following:

1. Photo of behind the wall for remote channel letters.
2. Weld photos from a multi---stage structure. You must provide progression photos, showing plug welds, cap ring, and flange welding.

Business Enterprise

Is your business:

minority-ownedwoman-owneddisadvantaged-ownednone of the above
Unions represented

Capabilities

Check all that apply.

Steel erectionSteel fabricationInstallation of new footingsElectrical installation of signsSign assemblyStructural engineeringElectrical engineering

Equipment

Check all that apply.

45’ bucket truck100’ crane35’ servicetruck65’ crane115’ crane55’ servicetruck85’ crane70’ service trucknone of the above

Coverage Area

Please provide a map of the area serviced. Note “Installation” and “Service” if different.

Insurance Coverage

Insurance coverage. Please attach, or forward, a copy of your insurance certificate. PSCO’s requirements are:

1. Commercial general liability:$1,000,000
2. Automobile liability:$1,000,000
3. Worker’s comp:$500,000

In addition, you must show that excess/umbrella liability limits are carried. You must provide a copy that shows the additional insured certificate holder as Philadelphia Sign Company; the certificate must have a cancellation clause of 30 days minimum written notice.

Refer to the sample certificate of insurance.

Trade references

These can be owners, architects,subcontractors, orsureties. Include company and contact name, address, and phone number. Applicationsthat do not include trade references will not be processed.

Company 1

Company Name
Contact
Phone
Email
Address Line 1
Address Line 2
City
State
Zip

Company 2

Company Name
Contact
Phone
Email
Address Line 1
Address Line 2
City
State
Zip

Include any additional information, notes, or comments that you want to have considered with this application.

Safety

Does your company have a safety program?YesNo
Are daily inspections made of all cranes/trucks?YesNo
Are the inspections documented?YesNo
Do you abide by all local/county/state/fed OSHA and regulatory agencies?YesNo
Number of OSHA violations in the last 3 years
Number of OSHA violations in the past year
Please indicate your insurance safety rating (DART RATE)
How often are safety meetings conducted?
Cranes required to be certified?YesNo
How often?

PSCO requires that:

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above.