Subcontractor RegistrationStart the process to become a Bergman Subcontractor: Legal Company Name * Name * First Name Last Name Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Website http:// What is your trade? Years in business? Backlog for the current and following year: Volume of the current projects under contract What certification do you have? (WBE / VBE / MBE / VOB / SDVOB / DOBE / LGBTQ) What is your EMR (Experience Modification Rate) for the past three years? How many jobsite injuries or property damage claims have you had over the past three years? Ownership Type * Corporation LLC Sole Proprietorship Partnership Geographic range for services: * 25 Miles 50 Miles 100 Miles U.S. Nationwide Union? * Yes No Safety Coefficient * 0 - 0.5 0.51 - 0.99 1 - 1.5 1.51 - 2 2.1 - 2.5 2.51 - 3 3.1 - 3.5 3.51 - 4 4.1 - 4.5 4.51 - 5 5+ Has the company worked under contract with Bergman in the past three years? * Yes No
