*Required fields
1.	Name of Company:*
2.	Name of Contact Person:*
	Business Address:*
	City, State, Zip:*
	Phone Number (include area code):*
	Fax Number (include area code):
	E-mail Address:*
3.	Type of Business:*	Select one... Incorporated Partnership Sole Proprietorship
	If incorporated, state resident agent and address. If partnership or sole proprietorship, state managing person and address:*	Name Address City, State, Zip
4.	How long has the company been in present business (in years)?*
5.	Does the contractor maintain: General liability insurance of at least $1,000,000 per occurrence; $1,000,000 aggregate, Combined Single Limit (CSL); and Automobile liability of at least $1,000,000 per accident CSL. *	Select one... Yes No
	If no, describe any differences to the specified coverage amounts:
6.	During the past five years has the contractor been involved in any:
	Construction bond forfeiture:*	Select one... Yes No
	Construction litigation:*	Select one... Yes No
	Claims exceeding ten     percent of the contract price:*	Select one... Yes No
	If so, describe below any reasons for forfeiture, litigation or claims:
7.	Has your company been disqualified by any public agency from participation in public contracts?*	Select one... Yes No
	If yes, identify the public agency, date and cause:
	Any criminal convictions, including pleas of nolo contendere, of the contractor, its owners of officers?*	Select one... Yes No
	If yes, please describe:
8.	Minority Contractor?*	Select one... Yes No
9.	Federal Tax Identification No.*
10.	State Licensing Information:
	State of Washington     Contractor's Registration No.*
	Contractor's Bond Information:
	Name of Bonding Company:*
	Amount of Bond:*
	Bond Number:*