Authorized Contractor Application

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Authorized Contractor Application

Directions for Application

1. Fill out complete application.
2. If the applicant already has a completed credit agreement with Gulf Coast Supply’s (GCSM) AR Department, it is not necessary to complete the financial sections of this application.
3. Attach valid proof of Liability Insurance, Worker’s Compensation Insurance and if applicable, business license(s) to work in the State(s)/Province(s) listed on application.

"*" indicates required fields

Step 1 of 10

Experience of Key Business Participants:

President Name*

First Last

President Years of Roofing Experience*

President Prior Construction Experience (Business, Type, Years)

Vice President Name*

First Last

Vice President Years of Roofing Experience*

Vice President Prior Construction Experience (Business, Type, Years)

Other Officer(s) Name(s)

First Last

Other Officer(s) Years of Experience*

Other Officer(s) Prior Construction Experience (Business, Type, Years)*

Estimator(s) Name

First Last

Estimator(s) Years of Experience*

Project Manager(s)

First Last

Project Manager(s) Years of Experience*

Supervisor(s)

First Last

Supervisor(s) Years of Experience*

What percent of your work is performed by your own employees?*

Please enter a number from 0 to 100.

List 5 projects of similar size and scope for which you're applying. Please include photos of completed projects.

Project One*

Project

Owner

Material Supplier

Project Size

Spec Description

Month/Year Completed

File

Max. file size: 100 MB.

Project Two*

Project

Owner

Material Supplier

Project Size

Spec Description

Month/Year Completed

File

Max. file size: 100 MB.

Project Three*

Project

Owner

Material Supplier

Project Size

Spec Description

Month/Year Completed

File

Max. file size: 100 MB.

Project Four*

Project

Owner

Material Supplier

Project Size

Spec Description

Month/Year Completed

File

Max. file size: 100 MB.

Project Five*

Project

Owner

Material Supplier

Project Size

Spec Description

Month/Year Completed

File

Max. file size: 100 MB.

Please upload a word document with additional projects completed in the last two years for each other category you are applying.

Drop files here or

Max. file size: 100 MB.

Include project, owner, material supplier, project size, spec description, and month/year completed for each project.

What quality control procedures do you normally apply to projects to assure proper installation?*

Financial Section

NOTE: If the applicant already has a completed credit agreement with GCSM's Accounts Receivable Department prior to applying to become a GCSM authorized contractor, it is not necessary to complete the financial sections of this application.

Do you already have a completed credit agreement with GCSM's Account Receivable Department?

Yes

Vendor One

Vendor Name

Address

Phone

Vendor Two

Vendor Name

Address

Phone

Vendor Three

Vendor Name

Address

Phone

Vendor Four

Vendor Name

Address

Phone

Bank Reference One:*

Bank

Address

Phone

Bank Reference Two:*

Bank

Address

Phone

Please list associations in which your firm holds memberships.*

Include association name, address, and phone number.

List manufacturers/marketers of roofing or waterproofing systems you have current applicator agreements with.*

Include company name(s) and type of agreement(s).

Signature Page

1. The undersigned officer of the business named below hereby certifies that the information provided herein is true and accurate, offered for the purpose of having Gulf Coast Supply and Manufacturing (GCSM) rely thereon, in order to approve this contractor's application as a GCSM Authorized Contractor (CONTRACTOR), which entitles such CONTRACTOR to apply for GCSM Warranties from GCSM and commits such entity to apply such systems in accordance with GCSM applicable specifications and good construction practices.
2. Contractor certifies by signing below that they hold all necessary licenses to perform roofing work in the jurisdictions listed on the application and agrees to notify GCSM if a necessary license expires, is revoked or otherwise terminated.
3. If the applicant already has a completed credit agreement with GCSM's Accounts Receivable Department prior to applying to become a GCSM authorized contractor, it is not necessary to complete the financial sections of this application.
4.
GCSM is hereby authorized to investigate credit history and Dunn & Bradstreet reports to confirm the data provided in this application.

Name*
First Last

Date*
MM slash DD slash YYYY

Signature*

The following must be attached to application for it to be processed:

Proof of Liability Insurance*
Max. file size: 100 MB.

Proof of Worker's Compensation (Canada - WSIB Clearance Letter/Certificate)*
Max. file size: 100 MB.

Copies of all business and contractor license(s) required to perform work in the states or province(s) listed on application.*
Max. file size: 100 MB.

Copies of your business's safety program*
Max. file size: 100 MB.

PLEASE ALLOW TWO WEEKS FOR REVIEW AND PROCESSING. YOU WILL BE NOTIFIED AS TO WHETHER OR NOT YOU AUTHORIZED WITHIN THAT TIME FRAME.

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