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Small Contractor Membership Application
Unity is Strength!
*
Indicates required field
Check one
*
Small Business ($250.00)
Individual / Non-Business ($150.00)
Non-profit organization ($500.00)
Political / Government ($1,000.00)
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]
.
Cash / Check Payment:
Cash or check payment is accepted. If by check, make payable to:
UNITED HISPANIC CONTRACTORS
Company Information
Company Name
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
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
*
Safety Coordinator
*
Phone Number
*
Phone Number
*
Email
*
Email
*
Is your business registered with the state
*
Yes
No
Wich State?
*
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?
*
Yes
No
How many employees do you have?
*
Do you have Bond Insurance?
*
Yes
No
What is your bonding limit? $
*
Seguridad (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:
*
White
Afro-American
Hispanic / Latino
American Indian / Native
Asian
Owner is:
*
Veteran
Veteran Disabled
The business is:
*
Part of a union
NOT part of a union
Type of business
*
General Contractor
Sub-Contractor
Manufacturer
Material supplier
Consultant
Service Provider
Other
Type of business
*
Upload your Logo
*
Max file size: 20MB
I agree to be a member of the United Hispanic Contractos Association and agree to all terms/rules of said organization:
*
Yes
Submit
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