join - United Hispanic Contractors

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Corporate Sponsor
Membership Application
Unity is Strength!

Membership & Payment (Annual)

* Indicates required field

Check one *

Bronze ($2,500) Silver ($5,000) Gold ($7,500) Platinum ($10,000) Titanium ($15,000) Infrastructure Partner ($25,000)

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 check.

Mailing 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 Comercial Industrial Other

What other service *

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

Owner Information / Licenses / Insurance / Security

Company Representantive *

#Tel *

Email *

Coordinador de seguridad *

#Tel *

Email *

Is your business registered with the state? *

Yes No

Which state? *

Starting date *

Legal type of company? *

EIN# (Federal Business Tax #) *

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

How many employees do you have (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 have other licenses? *

Yes No

Specify which 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 Workers' 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 *

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

Yes

Submit

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Office:
4104 S 42nd St., Omaha, NE 68107

Phone:
(531) 333-4646

Email:
[email protected]om

JOIN US

Corporate SponsorMembership ApplicationUnity is Strength!

GRACIAS A NUESTROS SPONSORS / THANKS TO OUR SPONSORS

Corporate Sponsor
Membership Application
Unity is Strength!