New Subcontractor/Supplier Information


Please take a moment to provide us with the following information to avoid any delays is processing your invoices.

Subcontractor Trade Name:

Legal Company Name (if different from above):

Owner’s Name:

Owner's Email:

Owner:

Project Contact Name:

Project Contact Email:

Project Contact:

Billing Contact Name:

Billing Contact Email:

Billing Contact:

Please check the box next to the authorized party who will be executing contracts and waivers on the Company's behalf. Subcontracts will be sent via DocuSign using that person's email as authorization.

Mailing Address:

Phone:

Fax:

FOR ALL SUBCONTRACTORS – ALL OF THE FOLLOWING MUST BE PROVIDED PRIOR TO ANY APPLICATION FOR PAYMENT

1. Contractor's License #:

Expires:

2. Current General Liability and Workers Compensation Insurance certificates with both our Companies as the additional insured: Delta Construction Services, LLC (If you are a Sole Proprietor, a Sole Proprietor Waiver for Worker Comp MUST be submitted and approved by Delta prior to any work being performed)

3. A completed and signed W-9 - https://www.irs.gov/pub/irs-pdf/fw9.pdf

4. Name and Title of person signing W-9:

Are you a single member LLC?

Upon the awarding of any project work, Delta will email:

• Delta will send via DocuSign a Subcontract for the project with your proposal attached – THIS MUST BE SIGNED
AND RETURNED PRIOR TO ANY WORK COMMENCING

• Please contact Nicole Tyler if you require any additional information for the project at [email protected]

Minimum Insurance Requirements

Project Name:

Project Number:

General Liability
- Each occurrence ………………………....$1,000,000
- Damage to Rented Premises …………..…$100,000
- Medical Expenses…………………….…..$5,000
- Personal and advertising injury…………...$1,000,000
- General Aggregate………………………..$2,000,000
- Products / Completed operations…………$2,000,000

Automobile Liability
- Combined Single Limit ………………..$1,000,000

Umbrella Liability
- Occurrence ……………………………..$1,000,000

Workers Compensation
- Each accident …………………………..…..$1,000,000
- Disease – Each Employee………….………$1,000,000
- Disease – Policy Limit…………….………$1,000,000

Please include wording per project
- Additional insured per form……
- Primary non contributory wording per form…….
- Waiver of subrogation per form………

Please provide us with the names and contact information of the suppliers you will be using for this project. Please remember to include a signed waiver from each supplier who has pre-leined our project thru the same billing period you are submitting for. Failure to do this will result in delays in processing your payment.

Supplier Name 1:

Phone Number 1:

Contact Name 1:

Contact Email 1:

Supplier Name 2:

Phone Number 2:

Contact Name 2:

Contact Email 2:

Supplier Name 3:

Phone Number 3:

Contact Name 3:

Contact Email 3:

Supplier Name 4:

Phone Number 4:

Contact Name 4:

Contact Email 4:

Please feel free to contact one of us for any questions you may have:

Brad Jones - GM - cell: 602-332-2053 - [email protected]

Anne Jones - Finance - cell: 602-369-8401 - [email protected]

Nicole Tyler - Project Coordinator - cell: 480-280-1350 - [email protected]

Delta Construction Services LLC
Office: 3420 E. Shea Blvd, Suite 145 Phx AZ 85028
Mailing: 10645 N. Tatum Blvd, #200-481 Phx AZ 85028
(o) 480-629-5271 (f) 480-907-1620

Leave this empty:

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Signature Certificate
Document name: New Subcontractor/Supplier Information
lock iconUnique Document ID: 9c29df8d4b88ac37b6be4f1031b691c007108145
Timestamp Audit
July 21, 2020 12:30 pm MSTNew Subcontractor/Supplier Information Uploaded by Anne Jones - [email protected] IP 2600:8800:1080:320:5dc1:b16:8e18:a9fc
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This audit trail report provides a detailed record of the online activity and events recorded for this document.
https://deltaconstructionaz.com/
Audit Trail Serial# 01e3a00e8172e8c9e887c51df53cb728