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2. Company Name*
4. Contact Name*
5. Title
7. Mailing Address*
8. City, State Zip
10. Street Address (if different from mailing address)
11. City, State, Zip
13. Phone Number*
14. Fax Number
16. Cell Phone
17. Email Address
19. Contractor License Number*
20. Expiration Date*
22. Washington State Tax Number
23. Federal Tax ID Number
25. ATTACH A COMPLETED W-9 TAX FORM WITH APPLICATION
27. Attach W-9 Here
29. Bonding Capacity
31. INCLUDE SPECIALTY PREFERENCE (see below)
33. Check Applicable Box(es)

    1. Registered with the State of Washington as a Woman Business Enterprise
    2. Registered with the State of Washington as a Disadvantaged Enterprise
    3. Registered with the State of Washington as a Minority Business Enterprise
35. By signature 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 my submittal of this application.
37. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
39. Electronic Signature
41. Indicate the categories that best describes the type of work your firm is qualified to perform:
43. Public Works
45. General Construction - Streets

    1. AC Paving
    2. Concrete - Curb & Gutter/Sideswalks
    3. Road Construction
    4. Rip-Rap/Stream Bank Stabilization
47. General Construction - Utilities

    1. Industrial Pump Repair
    2. Water Line Installation/Repair
49. Specialty Contractors

    1. Asphalt Patching
    2. Chip Sealing
    3. Fencing
    4. Hydro Seeding
    5. Landscape/Irrigation Installation
    6. Landscape Maintenance
    7. Side Sewer Construction
    8. Sidewalk Repair
    9. Guardrail Construction
    10. Traffic Control Specialist
    11. Marine Vessel Repair/Maintenance
51. Public Buildings
53. Construction - Buildings

    1. Alarm Systems
    2. Asbestos/Lead Abatement
    3. Building Construction (all phases)
    4. Carpentry/Remodeling
    5. Commercial Electrical
    6. Concrete (retaining walls, foundations, flat work)
    7. Demolition
    8. HVAC
    9. Hazardous Materials Cleanup
    10. Maintenance (window washing, carpet cleaning)
    11. Masonry
    12. Painting
    13. Plumbing
    14. Roofing
    15. Sprinkler Systems (fire)
    16. Underground Storage Tank Removal
    17. Window/Doors (repair/replacement)
    18. Other ______________________________________________________
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit Submit and Print

* indicates a required field