Contractor Registration

1. Contractor Name

2. DBA Name

3. Address

4a. Contact Name

4b. Contact Title

5. Contact Information

6. Federal Tax ID Number

7. DUNS Number (If applicable, smaller mom and pops won't typically have one)

8. Year company was established

9. Number of years of experience performing the installation of OSP facilities

10. Revenue for the last 3 years

11. Number of Employees

12. Current Customers

13. What states do you presently serve? (Check box)
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

14. What states are you interested in working? (Check box)
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

15. Technical Capabilities
OSP Engineering ServicesOSP Field Engineering ServicesOSP Underground and Aerial PEOSP Planning Services

16. Construction Capabilities
Aerial FiberAerial make read servicesPlowingBoringTrenchingRock SawingOTDR TestingFiber SplicingTest and turn up

17. Number of W2 construction employees

18. Number of W2 fiber splicers

19. Equipment (Please list the number owned for the following)

• Plows

• Bore Machines

• Trenchers

• Bucket Trucks

• OTDR Testing Equipment

20. Does your company have a safety program?
YesNo