Sub-Consultant Registration Step 2 Please complete the fields below to finish your registration. Authorized Representative First Name* Authorized Representative Last Name* Phone Number* E-mail Address* Are you requesting to join 4C Solutions as an Individual or a Company?*IndividualCompanyAre you legally enabled to work in the United States and territories? YesNoThe legal name you will be conducting business under and invoicing thru? The entity model you will be conducting business under and invoicing thru? Company’s state of registration? If presently operating as a company, is your entity in good legal standing with its Secretary of State? YesNoIf not presently operating as a limited liability entity, are you willing to do so? YesNoDoes your Company presently carry business owner’s liability insurance? YesNoIf so, liability limits?If not, are you willing to do so? YesNoDo you have a valid driver’s license? YesNoIf no, what is your means and mode of transportation for work purposes? If your assignment requires you to drive, you must carry current automobile insurance. Limits of liability?Do you presently carry health insurance? YesNoIf no, are you willing to do so at your own cost as a condition of engagement? YesNoAre you willing to submit to pre-assignment/random drug screening(s)? (Only when Regulatory or Engagement mandated?) YesNoWill You Submit to Background Check(s)? (Only when Regulatory or Engagement mandated?)YesNoHave you been convicted of any felonies within past twenty (20) years? YesNoIf yes, please elaborateAre you willing to adhere to ALL Health, Safety, Environment (HSE) and Engagement standards of the specific Client for which you are to be commissioned? YesNoAre you willing to provide two (2) current professional and two (2) personal references, with accompanying contact information? YesNoWill you invoice 4C, for approval and processing, twice per month within five (5) business days after the 15th of the month and the final billing day of the month? YesNoCompany's legal entity name? Company's state of registration? Is Company in Good Standing with its Registered Secretary of State? YesNoApproximate 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? YesNoAre Company’s employees legally enabled to work in the United States and territories? YesNoDoes Company provide its employee’s health & other benefits? YesNoDoes Company engage, under your Company’s control, certain sub-contractor companies or individuals in select Client approved circumstances? YesNoDoes Company carry current liability insurance? YesNoType and liability limits? Does your Company carry other relevant Client indemnifying insurance? YesNoIf yes, what type? Liability limits? Will Company indemnify 4C and Client for its defined scope delivery and Company’s Client engaged personnel under Company’s employ, or sub-contract, up to the amount invoiced through Company’s final engagement invoice?YesNoWill Company agree to require its assigned personnel to pre-assignment and/or random drug screening(s)? (Only when Regulatory or Engagement Mandated)YesNoWill Company conduct pre-engagement background check(s)? (Only when Regulatory or Engagement Mandated)YesNoWill Company adhere to all Health, Safety, Environment (HSE) and Engagement standards of the Client for which 4C is commissioned?YesNoWill Company provide three (3) current professional references, with accompanying contact information?YesNoWill 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?YesNoUsername* Password* Confirm Password* Only fill in if you are not human Login
