Contractor Information

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

Please click on the link below, then confirm that you have read, acknowledge and agree to the terms of the agreement to be considered for contracted DEMCO jobs.

ICA (Independent Contractor Agreement)

I,

certify that I am an authorized representative of

and have the authority to enter into this agreement.

Signature

Sign above

I understand that checking this box constitutes a legal signature confirming that I have read, acknowledge and agree to the terms of the ICA (Independent Contractor Agreement).

Company Information

Company Name

Company Name Change Within The Past 3 Years

List prior company names and the date the name was changed

Date of Company Name Change

Address

City/Town

State/Province

ZIP/Postal Code

Is this your billing address?

Yes

No

Address

City/Town

State/Province

ZIP/Postal Code

Phone Number

Website

Tax ID #

DUNS #

Louisiana Contractor License #

General Liability Insurance Limits

Company Contact Information

Contact Name

Title

Contact Phone Number

Contact Email Address

Emergency Contact Information

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Email

Labor Resources

Re-order	Labor Type	Qty	Labor ST Rate ($/hr)	Labor OT Rate ($/hr)	Weight	Operations
	Labor Type Labor Type Enter other…	Qty	Labor ST Rate ($/hr)	Labor OT Rate ($/hr)	Item weight

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Equipment Resources

Please list all equipment that you will furnish below. The suggested FEMA rate is a wet rate and includes fuel charges.

Download and Review the (FEMA) Schedule of Equipment Rates that is applicable to major disasters and emergencies. (DEMCO and Contractor) will apply these rates where needed.

Re-order	Equipment Type	Description	Std. Price ($/hr)	Wet?	Weight	Operations
	Equipment Type	Description	Std. Price ($/hr)	Wet? Yes No	Item weight

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OSHA

NAICS Codes