Subcontractor Employment Requirements

SUBCONTRACTOR EMPLOYMENT REQUIREMENTS

This document records the minimum administrative, safety, insurance, licensing and background requirements applicable to a subcontractor before assignment to a project. Complete all sections fully. Incomplete or false information may result in denial of access to the project site or termination of engagement.

Project and Parties

Prime Contractor:     Project Name:

Subcontractor Identification

Assignment / Position Information

Trade / Role:    Project Supervisor:

Licensing, Insurance and Bonding

Contractor License Number:    License Expiration:

General Liability — Carrier: Policy No.:

Workers' Compensation — Carrier: Policy No.:

Automobile Liability — Carrier: Policy No.:

Bonding (if required): Bonding Company: Bond No.:

Safety, Training and Site Access

The subcontractor affirms that its personnel assigned to the project will comply with all site safety rules and possess required training and personal protective equipment (PPE). Provide training verification below.

OSHA 10: Completed Date:    OSHA 30: Completed Date:

First Aid / CPR: Completed Date:

Site-specific orientation required prior to first day on site. Subcontractor is responsible for ensuring all personnel sign site safety acknowledgements and comply with hazard communication and permit requirements.

Employment History (Most Recent)

Education

Graduation Date:

Professional References

Legal Disclosures and Acknowledgements

Independent Contractor Acknowledgment: The subcontractor acknowledges and agrees that it and its personnel are independent contractors and not employees of the Prime Contractor. The subcontractor is solely responsible for payment of its own taxes, benefits and insurance, and for compliance with all laws applicable to its business operations and personnel.

Equal Opportunity / Non-Discrimination: Selection for subcontractor engagement will be made without unlawful discrimination on the basis of race, color, religion, sex, national origin, disability, age, or other protected characteristic. Subcontractor warrants it does not engage in discriminatory employment practices.

Background Checks & Drug Testing: Subcontractor consents to background checks, criminal history reviews and controlled substance testing of the individual(s) assigned to the project where permitted by law. Refusal to submit to required testing or an adverse result where safety-sensitive duties are involved will disqualify the individual from site access.

Safety and Site Compliance: Subcontractor is responsible for ensuring crew competence, supervision, and adherence to site-specific safety plans, permits and procedures. Violations of safety rules may result in removal from the site and termination of the subcontractor’s access.

Certification and Authorization: By signing below, the undersigned certifies under penalty of perjury that all information provided on this form is true, complete and correct. The undersigned authorizes Prime Contractor and its agents to verify any information supplied, to contact prior employers and references, to obtain background checks and drug testing reports, and to verify insurance and licensing. The undersigned understands that false statements or omissions are grounds for denial of engagement or removal from the project and may subject the subcontractor to liability for damages.

Consent to Background Check and Drug Testing: I consent to background checks and reference verification.    I consent to drug/alcohol testing as required by site policy.

Applicant Certification

I certify that the information provided on this form is true, complete and accurate. I understand that any material misrepresentation or omission may result in denial of access or termination. I further certify that I will maintain required insurance, licenses, training and certifications for the duration of my engagement and will promptly notify the Prime Contractor of any changes to coverage or licensure.

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