Vendor Partner Application

Corporate Office

Company Name

Address

City

State / Provence

Zip Code / Postal Code

Website / URL

Business Contact Name

Business Contact Phone Number

Business Contact Email

Other Locations / Offices

Union Affiliation

IBEW
CWA
IBEW & CWA
Non-union

What % of your annual revenue is from national providers such as Bailiwick?

Please provide an overview of your organization and its history.

Please provide an overview of the most common type(s) of work your company performs. Be detailed and this is not meant to be all inclusive of your skills, rather the work you perform with the most frequency.

At the time of onboarding, Bailiwick requires our Vendors be on direct deposit for payments. Is your company willing to do direct deposit?

Yes, we will use direct deposit

List all relevant certifications your company holds

Are you fully licensed to conduct all aspects of your trade in the states you operate in?

Yes
No

Does your company have a written Safety Program?

Yes
No

Details on your safety program

Does your company have a written Quality Control Program?

Yes
No

Details on your quality control program.

Use of Bailiwick’s field app is a requirement for all technicians to upload deliverables. Is your company willing to use the app to complete Bailiwick work?

Yes, we will use the Bailiwick field app

How did you hear about us?

Which Social Media?

Do you have a name, URL, or other details?

If you have any additional details on your referal, please place them here.

COI Insurance Requirements

The following insurance requirements are required of all vendor partners.

General Liability ($1,000,000 each: General Aggregate, Personal Injury, Completed Work & Products, & Per Occurrence coverage)
Auto Insurance ($1,000,000 coverage)
Workers Comp / Clearance Insurance ($100,000 – $500,000 – $100,000 coverage)

Checkboxes

By checking this box you agree to meet the insurance requirements.

Personnel

Number of W2 Technicians

Do you perform drug screening as a condition of employment?

Yes
No

It is our preference you are able to answer yes to the drug & background requirements, if not we MAY not reach out to you.

How many drugs do you screen and at what panel level?

Do you perform regular follow-up drug screening tests for existing employees (either randomly or at regular follow-up intervals)?

Yes
No

Do you perform background checks as a condition of employment?

Yes
No

Do your background checks look back at least 7 years?

Yes
No

Do your background checks include at least the following items: criminal history, driving record, name/address validation, professional license verification search?

Yes
No

Do you perform criminal background follow-up checks for existing employees (either randomly or at regular follow-up intervals)?

Yes
No

What type of work are you looking for?

Digital Signage Installation
General / Low Voltage

Skill Capabilities

Check all capabilities you offer.
All rates in U.S. Dollars($) and should assume standard daytime dispatch Rates entered may impact our response.

Checkboxes

Standard Low Voltage Tech (any low voltage tasks, including cabling, POS or Network device installation, CCTV)
Electrician (If applicable)

Standard Low Voltage Tech Rate

Electrician Rate

Digital Signage Questions

All of our projects require our Vendor Partners to be able to self-perform outdoor menu boards/sign settings. By checking this box you are confirming you can do this.

Yes odmb

Yes, I can self-perform outdoor menu boards/sign settings

Can you self-perform installing concrete foundations?

Yes
No

Can you self-perform excavation?

Yes
No

Are you capable of terminating Cat 5/6 cable and testing it?

Yes
No

Has your company completed drive thru menu board installation work in the past?

Yes
No

Please provide a description of the work you have done (quantity, type, scope, customer).

How would you classify your core business?

Sign Installation Only (setting sign and terminating low and high voltage)
Turnkey Sign Installation (earthwork, concrete, and sign installation)
General Contractor (you can subcontract multiple scopes to complete a project while self-performing some)
Other, not listed

Please explain your core business

Other information you would like to share?