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NRGC, Inc.

Subcontractor Application

Please fill in the form below

Types of workCommercial  Retail  Both
Company Name
Fed ID#
Contact Name
Address 1
Address 2
City
State
Zip
Phone
Fax
E-Mail
Years in Business
Number of Employees
Contractor License?Yes No
License State(s)
License Number(s)
License Classes

Scope of Work Performed

Acoustical Ceiling
Alarm Systems
Awning & Canopy
Cable Installation
Carpet
Ceramic Tile
Cleaning
Communications
Compaction Testing
Concrete
Concrete Testing
Concrete Cutting & Coring
Demolition
Doors & Hardware
Drywall
Electrical
Equipment Rental
Fixture Install
Fire Protection
Fire Sprinklers
Framing
Generators
Glass Storefront
Glass & Windows
Grading
HVAC
Insulation
Landscaping
Metal Fabrications
Microwave Installation
Painting
Plumbing
Paving
Roofing
Screening
Signs
Structural Steel
Tower Erection
Trenching
Wall Coverings
Wood Flooring
Other
Other
Other
Other

Insurance Information

General Liability Insurance?Yes No  
Limit
Workers Comp Insurance?Yes No  
Limit
Commercial Auto Insurance?Yes No  
Limit
Umbrella/Excess Insurance?Yes No  
Limit
Professional Liability Insurance?Yes No  
Limit
Other Insurance?  
Limit
Other Insurance?  
Limit

Safety Information

Has applicant had any safety violations in the last 3 years?Yes No
Does applicant have a safety manual?Yes No
Safety Manager Name
Safety Manager Phone
Number of jobs applicant can complete monthly
Average size of each job
Name of person completing application
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All company, brand, and product names are registered trademarks of their respective holders.