Bergeron Emergency Services Sub-Contractor Form

The Bergeron Emergency Services team is committed to providing business opportunities to local contractors and consultants to meet and/or exceed Minority and Women-Owned Business Enterprise (M/WBE) goals.

Subcontractors from every discipline and any geographical area are encouraged to register with us. All firms interested in conducting business with Bergeron as a subcontractor or sub-consultant are encouraged to complete and submit the form below to be included in our database.

Company Name: *

Contact Name: *

Address: *

City: *

State: *

Zip: *

Phone: *

Fax:

Your Email:

General Contractor’s License Number:

Type of work requesting to perform (debris removal, debris processing, etc.):

Is your company certified?

YesNo

FEIN #:

Is your company bondable?

YesNo

If yes, please upload a letter from your bonding company evidencing your bonding terms for project limit and aggregate limit.

Has your company had experience with Disaster Recovery Services projects?

YesNo

If YES Please explain:

Project History and Amount:

Who were you contracted with (contact person):

Upload any recommendation letters:

Additional Document:

Additional Document: