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K L I C K I T A T C O U N T Y P U B L I C W O R K S D E P A R T M E N T 228 W. MAIN ST., MS-CH 19, GOLDENDALE WASHINGTON 98620 • FAX [PHONE REDACTED] • VOICE [PHONE REDACTED] SMALL WORKS ROSTER APPLICATION 2017 COMPANY MAILING CITY: CONTRACTOR REGISTRATION FEDERAL TAX ID OR SOCIAL SECURITY MINORITY/WOMEN OWNED BUSINESS: MBE WBE DBE CERTIFICATION BONDING CAPACITY: $300,000 OR LIST DOLLAR AMOUNT INSURANCE 1. Return application and specialty preference to: Klickitat County Public Works Dept, 228 West Main St., MS-CH-19, Goldendale, WA 98620 before January 31, 2017. 2. Incomplete applications will not be accepted. 3. When using the small works roster to award contracts in the amount of $300,000 or less the County will invite proposals from a minimum of three appropriate contractors on the small works roster and whenever possible, will invite at least one proposal from a minority or woman contractor who otherwise qualifies. The contract will be awarded to the contractor submitting the lowest responsible bid. 4. Questions concerning this application may be directed to the Public Works Department: (509) 773-4616. 5. Roster effective until January 31, 2018. 6. 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. Signature: Date: Name and Title of Preparer (Typed or Printed) ---PAGE BREAK--- K L I C K I T A T C O U N T Y P U B L I C W O R K S D E P A R T M E N T 228 W. MAIN ST., MS-CH 19, GOLDENDALE WASHINGTON 98620 • FAX [PHONE REDACTED] • VOICE [PHONE REDACTED] Check box(s) that best describes the type of contract your firm qualifies to perform PUBLIC WORKS General Construction – Roads/Streets: Bridge Road and Street Construction Specialty Contractor: Chip Sealing/Paving/Cracksealing Crushing/Mining Clearing/Grubbing Drilling (Core/Water) Erosion/Dust Control Excavation Fencing Guardrail Hydroseeding Rotomilling Signs Snow Removal Soil Stabilization Tree Trimming/Removal Trucking Other (Please Describe Below) PUBLIC BUILDING General Construction – Building: General Building Contractor Alarm Systems Radio Communication Asbestos/Lead/Mold Abatement/Remediation Roofing Building Construction (all phases) Site Preparation Carpentry/Remodeling Sprinkler Systems (fire) Concrete (retaining walls, foundations, flat work) Underground Storage Tank Removal Demolition Utilities (Installation/buried/aerial) Electrical Windows/Doors/Overhead Doors) Elevator – Service/Maintenance Painting (Interior/Exterior/Coatings) Fire Extinguisher Service Property Abatement. Floors Generator Sales/Installation Hazardous Materials Cleanup HVAC Janitorial Lawn/Landscaping Masonry Sidewalk Repair Plumbing Other (Please Describe Below) ---PAGE BREAK--- K L I C K I T A T C O U N T Y P U B L I C W O R K S D E P A R T M E N T 228 W. MAIN ST., MS-CH 19, GOLDENDALE WASHINGTON 98620 • FAX [PHONE REDACTED] • VOICE [PHONE REDACTED]