Vendor / Subcontractor Application

Primary Point of Contact

Business Size & Revenue

Number of Employees

Work Comp EMR

Safety & Compliance

Written safety program?

Yes

No

Files OSHA reports?

Yes

No

Employee training program?

Yes

No

Alcohol / drug prevention program?

Yes

No

Uses SCR for preliminary lien notices?

Yes

No

Uses purchase order systems?

Yes

No

Legal History

Bankruptcy / receivership / reorganization?

Yes

No

Ever failed to complete a contract?

Yes

No

Any liens or claims pending?

Yes

No

Currently in litigation or arbitration?

Yes

No

OSHA violations in past 3 years?

Yes

No

Project References (Last 3 Years)

Please provide past or current projects completed within the last three years.

Business Experience & Qualifications

Explanation for Yes Answers (Section 9)

Required Documents

Please upload the following required documents. All files must be current.

General Liability Insurance CertificatePatterson Homes must be listed as the Certificate Holder

Work Comp Insurance OR Work Comp Waiver

Copy of Current Contractor License (if applicable)

Current W9 Form