Quadrant homes

Company Name: *

Type of Work Performed: *

Physical Address: *

Mailing Address:

Contact: *

Title / Role: *

Email *:

Primary Phone Number: *

Secondary Phone Number:

Fax Number:

Number of Years in Business:

Number of Employees:

Labor Type: * Choose... Subcontracted Labor In-house Labor Combination

Key Brands / Suppliers:

Key Distributors:

Other Residential Customers / References: *

Number of Residential Units per Year: *

Annual Revenue:

Geographical Range of Operations: * (other locations)

Do you carry insurance that meets previously outlined insurance requirements? * Yes No

Current Company RIR: * (recordable incident rate)

Labor and Industries Number: *

Workers Comp Experience Rating:

Does your company have a Safety
Manager?: * Yes No

Do you have a written health and safety
plan? * Yes No