Vendor Pre-Qualification | U.S.A. Disaster Site Worker Services

Vendor Information

U.S.A. Disaster Site Worker Services evaluates potential vendors and service providers based on organizational needs, project requirements, qualifications, experience, safety practices, insurance information and other relevant factors.

Disaster response and recovery environments may involve rapidly changing conditions and specialized hazards. Vendors are responsible for maintaining qualifications, licenses, insurance, training and regulatory compliance applicable to the work they perform.

Important: Submission of this form does not constitute approval, certification, a contract, an offer of work, placement on an approved-vendor list, or a guarantee of future business.

1. Company Information

Legal Company Name *

DBA / Trade Name

Primary Contact *

Contact Title

Email *

Phone *

Business Address *

City *

State / Territory *

ZIP / Postal Code *

Company Website

Year Established

Number of Employees

Business Structure

EIN / Tax ID

2. Services & Capabilities

Services / Products Provided *

Geographic Service Area

Disaster Response / Recovery Experience

Disaster-Site Capabilities

3. Insurance Information

General Liability

Workers' Compensation

Commercial Auto

Professional Liability / E&O

Primary Insurance Carrier

Policy Expiration

4. Safety & Compliance

Written Safety & Health Program

OSHA Citations Within the Last 3 Years

Citation Details

Licenses, Certifications, Training & Qualifications

5. Business References

Reference 1 - Company

Reference 1 - Contact

Reference 1 - Phone / Email / Project Information

Reference 2 - Company

Reference 2 - Contact

Reference 2 - Phone / Email / Project Information

6. Certification

I certify that the information provided in this Vendor Pre-Qualification submission is accurate and complete to the best of my knowledge. I understand that U.S.A. Disaster Site Worker Services may request additional documentation or verification and that submission does not guarantee approval, future work, contractual relationship, vendor status or any business opportunity. *

Authorized Representative *

Title *

Vendor Questions

For questions concerning the Vendor Pre-Qualification process, contact:

U.S.A. Disaster Site Worker Services
Email: office@usadsws.org
Phone: (407) 434-9859
Fax: (407) 201-4443