Contractor Information

Please download ICA (Independent Contractor Agreement).

You must agree to the ICA (Independent Contractor Agreement) to submit company information and be considered for contracted DEMCO jobs.

I, certify that I am an authorized representive of
and have the authority to enter into this agreement.
Company Information
List prior company names and the date name was changed.
Date of when the company name was changed.
Billing Address
Company Contact Information
Emergency Contact Information
Company Services Offered
REQUIRED: Please indicate the services your company can provide. Please select all that are applicable.
National Council on Compensation (NCCI) documents or insurance letter listing Experience Modifier Rate (EMR) for the last 3 years
Files must be less than 2 MB.
Allowed file types: txt pdf doc docx.
OSHA 300 and 300A logs for the last 3 years
Files must be less than 2 MB.
Allowed file types: txt pdf doc docx.
OSHA citations issued within the last 3 years
Files must be less than 2 MB.
Allowed file types: txt pdf doc docx.
Download Contractor Pre-Qualifcation Form
Files must be less than 2 MB.
Allowed file types: txt pdf doc docx.
Special Economic Status
Select all that apply.
Labor Resources
$ /hour
$ /hour
$
$ /hour
$ /hour
$ /hour
Please describe.
$ /hour
$ /hour
$ /hour
$ /hour
$ /hour
$ /hour
Equipment Resources
Please list all equipment that you will furnish below. The suggested FEMA rate is a wet rate and includes fuel charges. Download & review the (FEMA) Schedule of Equipment Rates that is applicable to major disasters and emergencies. (DEMCO and Contractor) will apply these rates where needed.
$ /hour
$ /hour
$ /hour
$ /hour
$ /hour
$ /hour
Attachments
Each file attachment must be less than 2 MB. Allowed file types jpg, jpeg, txt, pdf, doc, docx.
DEMCO must be listed as Additional Insured.
Files must be less than 2 MB.
Allowed file types: jpg jpeg txt pdf doc.
Files must be less than 2 MB.
Allowed file types: jpg jpeg txt pdf doc docx.
Files must be less than 2 MB.
Allowed file types: jpg jpeg txt pdf doc docx.
Files must be less than 2 MB.
Allowed file types: jpg jpeg txt pdf doc docx.
Files must be less than 2 MB.
Allowed file types: jpg jpeg txt pdf doc docx.