Subcontractors

Vendor Information Packet
Before completing this form we recommend you have copies of the following documents:
Thank you for your time and attention in providing the information and representations requested herein. CPR Builders Inc. intends to and will reply upon the responses you provide below. Please ensure that the answers you provide are true, correct, and current. After submission, you agree to notify us immediately, in writing of any change affecting any item in this Vendor Information Packet or any occurrence of condition that may affect CPR Builders Inc.’s decision to engage or to continue to work with your firm. Examples included but are not limited to: changes in insurance coverage, changes in the status of any license(s), changes in company name, location, or key contacts, lawsuits, etc.

When completed please email the following requested documents to:

[email protected]
- Licenses
- W-9 Form
- Insurance Requirements for
  - Liability
  - Worker’s Compensation
  - Commercial Auto
Please review for specific insurance requirements that apply to you and attach copies of proof of Insurance.
*If you become an approved vendor and a project is granted to you, we will request insurance certificates to list CPR Builders Inc. as a certificate holder and additionally insured as well as the company which you will be providing service or perform work.
Insurance Certificates for approved projects: In order to perform work, Insurance Certificates will have to be issued and the endorsement should read: CPR Builders Inc. and the job name.
Company Name*
DBA Name
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner's Name*
Phone Number*
Please enter a valid phone number.
Email*
[email protected]
Website Address
Do you provide 24 hour service?*
Do you maintain an illness and injury prevention program?*
Business Type*
Have you worked for CPR Builders Inc. before?*
If yes, please list projects:
CPR Builders Inc. have a strict policy that any referrals, rebates or other monetary gratuities are prohibited and any vendor who is found to participate in such an arrangement will immediately be removed from our vendor list.

Your signature will certify that all the information provided on all pages of this Vendor Packet is accurate and will notify CPR Builders Inc. of any change(s) in the information.
Sign here*

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Today's Date*

MonthDayYear
Date

License Information
Classify your service(s) or products (Ex: Air conditioning, Plumbing, Restoration):

Please provide your license number(s) and check the applicable box(es) on next page along with a copy of your license(s). By filling out this section, you are certifying that you, your company and your staff carry and maintain in good standing the appropriate licenses for any all work any of you any be engaged to perform.
Contractor's State License Number
General License (Type & License Number)
Certifications (Please provide a copy):
- ASB - Asbestos Certifications
- HAZ - Hazardous Substance Removal Certification
- HIC - Home Improvement Certification

Insurance Requirements
Commercial General Liability
- $2,000,000 General Aggregate
- $1,000,000 Products and Completed Operations Aggregate
- $1,000,000 Each Occurrence
CPR Builders Inc. and the project/work must be listed as a certified holder, additional insured and Additional Insured Endorsement for General Liability must read:

CPR Builders Inc. are named as Additional insured as per attached endorsement with respect to General Liability.

Commercial Auto Coverage
- $1,000,000 Combined Single Limit
- Must indicate coverage for (a) Any Auto, or (b) Owned, Hired or Borrowed and Non- owned Vehicle.
Statutory Workers Compensation Insurance

(Must include a Waiver of Subrogation)

The evidence of insurance must:
- Cover all operations of the insured, not just the project described in the agreement or contract.
- Not exclude any work vendor will provide for CPR Builders Inc.
- Provide at least 30 days’ notice of cancellation.
- List all subsidiaries or DBA’s covered by the certificate provided.
- Coverage must be placed with carriers rated not less than A-, VII by A.M Best & Co.
- Must be primary and non-contributory.
- Be completed in its entirety and signed.

Vendor Sole Proprietor/Independent Contractor Worker's Compensation Indemnity Agreement
(Only fill out this form if Sole Proprietor and no employees working with vendor)
The parties to the Agreement CPR Builders Inc. and Vendor Name(herein after referred to as the "Vendor") whose principal office is located at:
Street Address Address Line 2 City State Zip
Dated Today: Date
1 . Recitals
a. Vendor is an Independent Contractor performing work when request by CPR
Builders Inc.
b. Vendor is a Sole Proprietor who has elected not to obtain Workers'
Compensation Insurance
c. CPR Builder's Inc. and the projects managed, require all Vendors performing
work maintain Workers' Compensation Insurance and Vendor has requested a
waiver of this requirement.
2 . The parties acknowledge and confirm it is the explicit intention for an Independent Vendor relationship to be formed between the Vendor and CPR Builders Inc. client and not that of an employer-employee.
3 . CPR Builders Inc. understands and the Vendor hereby affirms that it is regularly engaged in the independent business/profession of; Type of Service , and that the Vendor provides these services to other parties and is otherwise an independent Vendor for all purposes relative to this agreement and not an employee of an Association..
4 . The Vendor represents and warrants to CPR Builders Inc. that it has no employees itself and that if in the future it ever has employees, teh Vendor will immediately obtain Workers' Compensation Insurance and provide CPR Builders Inc. with original insurance certificates for Workers' Compensation coverage.
5 . The Vendor agrees to indemnify hold harmless and defend CPR Builders Inc., and the Project(s) he'she is performing work for, from and against all claims, demands, and suits for injuries suffered by the Vendor and/or Vendor's officers, agents, sub-vendors, or by any employeee of and sub-vendor while working for CPR Builders Inc.
6 . If, notwithstanding the foregoing, the Association is charged additional Workers' Compensation premiums by its insurer based upon the compensation paid to the Vendor, the Contractor agrees to immediately pay the Association the amount of such additional premium.
7 . A party shall not assign its rights and/or obligations under this agreement without the prior written consent of the other party.

Disclosure
Contractor is not entitled to Workers’ Compensation benefits or unemployment insurance benefits unless such compensation coverage is provided by the contractor or some entity other than the CPR Builders Inc. and the Contractor is obligated to pay Federal and State Income Tax on any monies earned pursuant to this agreement.
Contractor Name*
Signature*

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Date*

MonthDayYear
Date
Should be Empty:

Vendor Information Packet

License Information

Vendor Contractors State Licenses Classifications

Insurance Requirements

Vendor Sole Proprietor/Independent Contractor Worker's Compensation Indemnity Agreement

Disclosure

Location