Sub-Consultant MSA – 4C Solutions

Name*

First Last

Phone*

Email*

Enter your Initials*

Please enter your initials (FirstMiddleLast) to be used for your 4C Solutions profile.

Does your company or limited liability entity have more than one individual who will be providing services under this agreement?*

Are you requesting to join 4C Solutions as an Individual Operator or a Support Services Company?

All Sub-Consulting individuals attached to 4C in a professional capacity, are required to operate as a formal legal entity, such as an LLC.

Select Support Services Companies attached to 4C in a Sub-Consulting capacity, such as entities who offer land, survey, engineering, subsurface utility inspection, environmental and/or other project staffing, as examples, must be in incorporated good standing, with all applicable insurances, certifications and licenses in place. These entities must have a verifiable, multi-year, multi-project record of high performance within the Infrastructure Space relating to stated skill sets.

Support Services Company Name

Are you legally enabled to work in the United States and territories?*

Yes
No

Are you presently operating as a legal business entity, such as an LLC or Corporation?*

Yes
No

If not presently operating as a legal business entity, such as an LLC or Corporation, are you willing to do so?*

Yes
No

4C Solutions requires Sub-Consultants to register as a legal business entity. Please continue your application and refer to The Balance Small Business for more information.

For additional process guidance, please feel free to contact:
Dan Doherty
Dan@DanielDohertyLaw.com

What is the entity model you plan to conduct business under and invoicing thru?

Business Insurance Information

We additionally ask our Sub-Consultants to have Business Insurance. As you set up your legal business entity, if you are looking for Business Insurance, please consider Rocky Mountain West Insurance.

The legal name you will be conducting business under and invoicing thru?*

Company's legal entity name

The entity model you will be conducting business under and invoicing thru?*

Company’s state of registration?*

Address*

Street Address Address Line 2 City Please use 2 letter state code. ZIP / Postal Code Country

Is your entity in good legal standing with its Secretary of State?*

Yes
No

Does your Company presently carry Business Owner’s Liability Insurance?*

Yes
No

If so, liability limits?*

If not, are you willing to do so?*

(Example: The Hartford – Spectrum Business Owner’s Policy)

Yes
No

Please Note:

4C Solutions requires Sub-Consultants to carry Business Insurance prior to engaging in a Work Order with our Clients.

The purpose of this insurance is for the protection of our Sub-Consultant’s legal entity, 4C Solutions and our Client in the unlikely event of an accident, a performance dispute or other action(s) resulting in claims or legal action.

Business Insurance Information: Rocky Mountain West Insurance

If you are looking for Business Insurance, please consider Rocky Mountain West Insurance.

Do you have a valid driver’s license?*

Yes
No

If your assignment requires you to drive, you must carry current automobile insurance. Limits of liability?*

If no, what is your means and mode of transportation for work purposes?

Do you presently carry health insurance?*

Yes
No

If no, are you willing to do so at your own cost as a condition of engagement?

Yes
No

What is your highest level of formal education completed?*

Please specify where*

Specify your degree designation*

Do you have any additional certifications?*

Are you willing to submit to pre-assignment/random drug screening(s)? (Only when Regulatory or Engagement mandated?)*

Yes
No

Will You Submit to Background Check(s)? (Only when Regulatory or Engagement mandated?)*

Yes
No

Have you been convicted of any felonies within past twenty (20) years?*

Yes
No

If yes, please elaborate.*

Are you willing to adhere to ALL Health, Safety, Environment (HSE) and Engagement standards of the specific Client for which you are to be commissioned?*

Yes
No

Are you willing to provide two (2) current professional and two (2) personal references, with accompanying contact information?*

Yes
No

Please list references below

(name, company, position, contact information OR name, relationship, contact)

Will you invoice 4C, for approval and processing, twice per month within three (3) business days after the 15th of the month and the final billing day of the month?*

Yes
No

Is Company in Good Standing with its Registered Secretary of State?*

Yes
No

Approximate number of years has company been operational?*

Company headquarters:*

Company’s authorized representative:*

Authorized representative title:*

Office Location:*

Company Website URL:

Will Company assign W2 employees to 4C work Engagements?*

Yes
No

Are Company’s employees legally enabled to work in the United States and territories?*

Yes
No

Does Company provide its employee’s health & other benefits?*

Yes
No

Does Company engage, under your Company’s control, certain sub-contractor companies or individuals in select Client approved circumstances?*

Yes
No

Does Company carry current Liability Insurance?*

Yes
No

Type and liability limits?*

Does your Company carry other business insurance?*

Eg. Professional Liability

Yes
No

If yes, what type?

Liability limits?

Will your Company hold 4C and the Client harmless from your Company's professional negligence and indemnify them for any claims of personal injury by your assigned personnel and for any claims of any third party arising from your Company’s performance in providing services under the Agreement with 4C Solutions?*

Yes
No

Will Company agree to require its assigned personnel to pre-assignment and/or random drug screening(s)? (Only when Regulatory or Engagement Mandated)*

Yes
No

Will Company conduct pre-engagement background check(s)? (Only when Regulatory or Engagement Mandated)*

Yes
No

Will Company adhere to all Health, Safety, Environment (HSE) and Engagement standards of the Client for which 4C is commissioned?*

Yes
No

Will Company provide three (3) current professional references, with accompanying contact information?*

Yes
No

Please list references below*

(name, company, position, contact information)

Will Company invoice 4C, for approval and processing, twice per month within seven (7) business days after the 15th of the month and the final billing day of the month?*

Yes
No

I attest that the information I have entered here is true and accurate.*

I agree

Sub-Consultant Application

Step 1 of 3

Application Steps

4C SOLUTIONS