South County Fire Board Up Program Application
Please review the General Procedures document before applying. Pay close attention to section D and attachment A.
Contractor Information
Company Name
*
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Contact Name
*
First Name
Last Name
Primary Contact Email
*
example@example.com
Primary Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Company Website (if applicable)
Licensing & Business Credentials
Enter a valid contractor's license number issued by the State of Washington for this business
*
Upload a copy of your contractor's license.
*
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Do you have at least two (2) years of experience as a licensed General Contractor within the last five (5) years?
*
Yes
No
If yes, please briefly summarize relevant experience:
Do you possess a valid business license for all participating cities (Edmonds, Brier, Lynnwood, Mill Creek, Mountlake Terrace) and Snohomish County?
*
Yes
No
Upload copies of all applicable licenses.
*
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Do you have a fidelity bond of at least $25,000?
*
Yes
No
Upload proof of bond.
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Unfortunately, you do not meet the minimum qualifications as outlined in section B of the attached document.
If you feel this is incorrect, please go back and resubmit your application.
Insurance Requirements
Do you maintain workers’ compensation insurance for all employees engaged in work under this program?
*
Yes
No
If yes, attach a certificate of insurance.
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Do you have automobile liability insurance with a minimum of $3,000,000 combined single limit for bodily injury and property damage?
*
Yes
No
If yes, attach proof of insurance.
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Do you maintain general liability insurance with a minimum of $1,000,000 per occurrence for bodily injury and property damage?
*
Yes
No
If yes, attach a certificate of insurance.
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Operational Readiness
Do you agree to maintain an updated contact list of personnel, including job titles, who may be dispatched for emergency board-up services?
*
Yes
No
If yes, provide a current list
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Do you understand and agree to the expectation of arrival on scene within 60 minutes of notification?
*
Yes
No
Do you understand and agree that all payments for work performed will come solely from the insurance provider of the affected property?
*
Yes
No
Do you understand and agree that if insurance is non-existent, insufficient, or denied, your company will absorb the costs of services provided?
*
Yes
No
Do you understand that subcontracting work under this program is not permitted?
*
Yes
No
Equipment and Materials
Does your company possess and maintain the required tools and supplies listed in Attachment A?
*
Yes
No
If yes, provide an inventory list or summary of compliance
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Compliance and Conduct
Do you agree to comply with all on-scene protocols, including reporting to the Incident Commander and following SCF directives?
*
Yes
No
Do you agree to exhibit professional conduct at all times and refrain from any prohibited behaviors outlined in the program guidelines?
*
Yes
No
Have you or your company ever been removed from a similar board-up program for failure to perform or misconduct?
*
Yes
No
If yes, provide details.
Acknowledgment and Certification
Authorized Representative
*
First Name
Last Name
I certify that all information provided in this application is accurate and that my company agrees to abide by the rules, regulations, and requirements of the South County Fire Board-Up Program.
*
Yes
No
Signature
*
Date
*
-
Month
-
Day
Year
Date
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Submit
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