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Coral Springs, FL
(602) 784-2823
info@supremeconnections.net
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About Us
Our Services
Our Process
Service Areas
Contact Us
Join Us
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Sub Contractor
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Company Information
Legal Business Name:
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DBA (If Applicable):
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Business Structure:
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--- Select Choice ---
LLC
Corporation
Sole Proprietor
Partnership
Office Phone:
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Email Address:
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Cell Phone:
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Website:
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Primary Contact Name:
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Street Address
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Address Line 1
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Zip Code
Trades Applying For:
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Low-Voltage Cabling
CCTV / Security Systems
Audio / Visual
Access Control
Fiber Optic Installation
Networking / IT Support
Electrician
General Labor
Smart Home Automation
Other
Business Details
Years in Business:
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Licensed State:
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Contractor License Number:
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EIN / Tax ID:
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Workers Compensation
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Yes
No
Exempt
General Liability Insurance
Carrier:
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Policy #:
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Coverage Amount:
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Bonded
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Yes
No
Bond Amount:
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Experience & Capabilities
Primary Services Description:
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Types of Past Projects:
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Typical Project Size:
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Service Areas:
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Number of Field Employees:
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Available Crew Size:
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Safety & Work Standards
Carrier: Layout Payment
Written Safety Plan
*
Yes
No
PPE Usage
*
Yes
No
OSHA Violations
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Yes
No
Background Checks
*
Yes
No
Software Used:
*
Tools, Equipment & Certifications
Tools/Equipment Owned:
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Certifications
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BICSI, OSHA 10/30, Low Voltage, etc.
References
Reference 1:
Reference 2:
Company
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Company
Contact
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Contact
Phone
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Phone
Project
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Project
Payment Information
Preferred Payment Method:
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Bank Name:
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Routing Number:
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Account Number:
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W-9 Attached:
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Availability
Start Date:
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Emergency Job Availability:
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Preferred Work Schedule:
Legal & Compliance
Litigation History:
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Agreement to Follow Rules
*
Yes
No
Professional Conduct Agreement
*
Yes
No
Certification & Signature
Applicant Name:
*
Title:
*
Date:
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Signature
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