Asplundh Tree Expert Company: Government Disaster Recovery

*Section 2 - Company Background*
Industry Work Performed:
States and Geographical Locations: (Please check only States/Regions where you are able to perform work)	AL AR FL GA IN KS LA MD MS MO NC SC TN TX VA WV
Available Inventory of Equipment and Personnel: (please attach a complete description and quantity of each item available)
Business’ or Proprietor’s Social Economic Status: (Check appropriate status; list SBA and or MOB, including certificate number and national origin)	Small Business
	Large Business
	Veteran Owned Small Business
	Small Disadvantaged Business
	Hub zone Small Business
	Woman Owned Small Business
Certificate Number: (list all certificate #’s):
Has your company ever leased employees (temporary) or hired employees (permanent) through an agency?	Yes No
Number of Employees:
Years in Business:
Banking Reference Name: Ph# and contact:
Bonding Reference Name: Ph# and contact:

*Section Three- Insurance Information*
AES requires all Subcontractors to hold a minimum amount of insurance coverage in order to comply with the Industry Standard. Please check off the appropriate box which states the amount of insurance you or your organization currently holds.
General Liability 1,000,000
General Liability Aggregate 2,000,000
General Liability Carrier
GL Amount
Auto Liability 1,000,000
Auto Carrier
Amount
Worker Compensation Statutory
If no then amount
Worker Compensation Carrier Amount
Excess Liability Carrier Amount
Experience Modifier Incident Rate
Can you finance work up to 45 days?	Yes No
Have you worked with us before?	Yes No
If so, when and where?

*Subcontractor Information Form*
Have you had any disputes within the last three years with a client or contractor in which either arbitration or litigation was initiated?	Yes No
If Yes, please explain in detail:
This form has been completed by:
Name:
Title:
Date:
Officer and or Owner:
Date:

708 Blair Mill Road • Willow Grove, PA 19090 • USA • 1-800-248-TREE • e-mail: info@asplundh.com