Subcontractor Prequalification
New Application

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If you are a new potential subconsultant to ECT or have been inactive for more than a year, please complete the form below. If you are unsure, contact Sheldon Nozik for this or any other questions related to this process.

Please note the following:

Asterisks indicate required fields.
If you were an approved, active subconsultant to ECT in the previous 12 months, please complete this renewal process.

Section 1: Subcontractor Information
Company Legal Name:*
Company legal name as it appears on the W-9.
Primary Mailing Address:*
Website:*
Name and title of H&S Manager:
If you don't have one, please write not applicable.
H&S Manager Phone:
H&S Manager Email:
Date*
Date Format: MM slash DD slash YYYY
Primary ECT contact(s) and office(s) most recently serviced.*
NAICS Code(s)
If you possess any of the following Business Certifications, please check all that apply:
- Small Business
- Non-profit Organization
- Woman Owned
- Disability Owned
- Veteran Owned
- Service‐Disabled Vet owned
- Black American owned
- Hispanic American owned
- Native American owned
- Asian‐Pacific American owned
- Subcontinent Asian American owned
- HUBZone Certified
- Other- Explain
- Not applicable
If you possess any of the following Business Certifications, please check all that apply:
If you selected "other," please specify below.
Section Two: Subcontractor Health & Safety Information
Please provide the following data for the last three years below:
Total Recordable Incident Rate (TRIR)
Days Away, Restricted, or Transferred (DART)
Experience Modification Rate (EMR)
If not applicable, please mark NA in the fields below.
TRIR*
2020 2019 2018
DART*
2020 2019 2018
EMR*
2021 2020 2019
Has your company received a citation from OSHA or state equivalent, or other agency regarding an injury or environmental incident within the past 5 years?*
- Yes
- No
If yes, please provide a brief summary:
Your response is limited to 400 characters.
Has your company experienced a work-related, OSHA defined severe injury including hospitalization, amputation, or death in the past 5 years?*
- Yes
- No
If yes, please provide a brief summary:
Your response is limited to 400 characters.
Do you have H&S program information available about your company?*
- Yes
- No
- Not applicable
H&S Program Information
If you said yes, please check all that apply for your company.
- We have a written H&S Program.
- We hold Tailgate/Job Site Safety Meetings.
- We have an Injury Management & Reporting Procedure.
- We have a written Hazard Communication (HazComm) policy/program.
- We have written H&S procedures for the work we may perform for ECT.
- We prepare job-specific health & safety plans and job safety and hazard assessments.
- We have a “Stop Work Authority” policy.
Section 3: Document Uploads
Upload the following supporting documents:
H&S Program Table of Contents
Drop files here or
OSHA 300 and 300A logs for 2020, 2019, and 2018.
Drop files here or
Explanation of any severe injuries, hospitalizations, deaths or citations in last 5 years
Drop files here or
On Insurance carrier letterhead, EMR verification for years 2020, 2019, and 2018.
Drop files here or
Sample of completed Job Safety Analysis (similar for work to be performed with ECT)
Drop files here or
Certificate of Insurance (COI)*
Scroll to the bottom of the page to view our COI requirements.
Drop files here or
Current W-9 form (Signed)*
A link to a fillable W-9 form is provided below.
Drop files here or
Business Certifications
If you answered yes to one or more of the Business Certifications in section one, please provide documentation.
Drop files here or
Context and Explanation
Should any of the requested information not be available or need explanation, please provide an explanation here.
Next Steps
Once your application is received, the information will be reviewed and you will be contacted either to confirm approval and active status in our system or to request additional or supplementary information such as HAZWOPER training certifications, procedural documentation, or other related information. To complete the application process, please complete the required signatures below. By signing below, I acknowledge the information provided is current and true and I have provided the support information requested or provided explanations why the information was not provided. Additionally, the submitting subcontractor agrees to follow ECT health & safety requirements and applicable state or federal health & safety regulations.
Signature
Name Title Date
Email
This field is for validation purposes and should be left unchanged.

ECT will contact approved consultants after January 1, 2022, with information on how to access a simplified renewal process.

View W-9 Form for Subcontractors

CLICK HERE TO VIEW THE REQUIREMENTS FOR THE SUBCONTRACTOR’S CERTIFICATE OF INSURANCE:

The certificate holder name/address shall be:
Environmental Consulting & Technology, Inc. and its Affiliates Attn: Risk Management Dept.
3701 NW 98th Street Gainesville, FL 32606-5004
RE: Approved Subcontractor Qualification List

General Liability with minimum limits of:

$1,000,000 – Each Occurrence
$2,000,000 – Products and Completed Operations
$2,000,000 – General Aggregate
Automobile Liability with minimum combined single limit of $1,000,000
Worker’s Compensation – statutory; Employers Liability – $1,000,000
Professional Liability (if required) with minimum limit of $1,000,000
Pollution Liability (if required) with minimum limit of $1,000,000

The certificate holder needs to be listed as an additional insured, as their interest appears, on the General Liability and Auto Liability policies. Workers Compensation needs to have a waiver of subrogation in favor of the certificate holder.

The NAIC number for each insurer needs to be shown.

If Worker’s Compensation is obtained through a Professional Employer Organization (aka PEO or employee/staff leasing company), the PEO must provide a certificate of insurance showing a “master list” of the employees being leased to the subcontractor and the specific period of time each employee is being leased.