SMALL HISPANIC CONTRACTORS MEMBERSHIP

Small Contractor Membership Application Unity is Strength!

PAYMENT & APPLICATION

Thank you for your application. One of our representatives will review your application. If we need any further information, we will get in contact with you. If your application was properly submitted, you will receive an electronic invoice via email you listed. You may pay via credit card or check.

Address: 4104 S 42nd Street, Omaha, NE 68107

If you have any questions regarding your membership payment or any other information, please do not hesitate in contacting us at

531-333-4646 or [email protected].

Check one *

Small busines ($250.00)

Non-profit organization ($500.00)

Political/Government ($1,000.00)

Cash / Check Payment: Cash or check payment is accepted. If by check, make payable to: UNITED HISPANIC CONTRACTORS

Company Information

Company Name *

Company web *

Adress *

City *

State *

Country *

Postal code *

Are you a member of Better Business Bureau (BBB)? *

Yes

No

Describe your business or service in detail *

Offers services *

Residential

Commercial

Industrial

Other

What other service?

Maximum project or job you can handle (in dollars) *

Owner Information / Licenses / Insurance / Security

Company Representative *

Phone Number *

Email *

Safety Coordinator *

Phone Number *

Email *

Is your business registered with the state *

Yes

No

Starting date *

Legal type of company? *

EIN# (Federal Business Tax #) *

How many employees do you have (full time)? *

How many employees do you hace (Part time)? *

Do you use subcontractors? *

Yes

No

Do you have a state contractor's license? *

Yes

No

Do you have a city contractor's license? *

Yes

No

Do you hace other licenses? *

Yes

No

Specify wich licenses or permits you have *

Category / Type of service offered (3 maximum categories) (Example: Framing, concrete painting, roofing, etc.) *

Insurance

Do you have General Liability Insurance? *

Yes

No

Maximum Coverage $ *

Do you have Worker's Compensation Insurance? *

Si

No

How many employees do you have? *

Do you have Bond Insurance? *

Yes

No

What is your bonding limit? $ *

Safety

Do you have OSHA 10? *

Yes

No

Do you have OSHA 30? *

Yes

No

Do you perform project safety inspections? *

Yes

No

Do you have a drug testing program? *

Yes

No

Does your company have a written safety program? *

Yes

No

Do you have an orientation program for New Hires? *

Yes

No

Supervisors or Sub-Contractors? *

Yes

No

How often do you hold safety meetings? *

The following information is for statistical purposes only (optional)

Do you consider your company as a small business?

Yes

No

Owner is:

Male

Female

Owner is:

Veteran

Veteran Disabled

The business is:

Part of a union

NOT Part of a union

Type of business

Company Logo

I agree to be a member of the United Hispanic Contractos Association and agree to all terms/rules of said organization: *

Si

Gracias a nuestros patrocinadores / Thank you to our sponsors!

PODCAST

GALERÍA

CONTACTO

Office:

4104 S 42nd St., Omaha, NE 68107

Phone:

(531) 333-4646

Email:

[email protected]

SMALL HISPANIC CONTRACTORS MEMBERSHIP

Small Contractor Membership Application Unity is Strength!

Gracias a nuestros patrocinadores / Thank you to our sponsors!

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