SUBCONTRACTOR REGISTRATION FORM GENERAL COMPANY INFORMATION *Required FieldCompany* Federal Identification Number Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Business Phone*Business FaxCell Phone*Website Availability Check this box if your resources are currently availableCounty Waste Experience Check this box if you have previously worked with County WasteCounty Waste Previous Experience SERVICES PROVIDED CHECK ALL THAT APPLY Emergency Road Clearance Debris Collection Site Management Debris Reduction Tree Trimming and Removal Hauling Permitted Solid Waste Facility Stumps Snow Removal Project Staffing Marine Debris Removal Sand Screening Recycling Household Hazardous Waste EQUIPMENT OWNED (DO NOT INCLUDE ANY SUBCONTRACTED EQUIPMENT)Self LoaderQty1234567891011121314151617181920212223242526272829303132333435Self Loader with TrailerQty1234567891011121314151617181920212223242526272829303132333435Skid LoaderQty1234567891011121314151617181920212223242526272829303132333435Front End LoaderQty1234567891011121314151617181920212223242526272829303132333435Rubber Tire ExcavatorQty1234567891011121314151617181920212223242526272829303132333435Tub/Horizontal GrinderQty1234567891011121314151617181920212223242526272829303132333435Bucket Truck (<50' boom)Qty1234567891011121314151617181920212223242526272829303132333435Bucket Truck (>50' boom)Qty1234567891011121314151617181920212223242526272829303132333435Walking FloorQty1234567891011121314151617181920212223242526272829303132333435Comments Disclaimer: By providing the information requested to County Waste, you promise that all information you provide will be accurate, current and truthful to the best of your knowledge. You further agree and acknowledge that County Waste will be relying on the information, that County Waste has no obligation to retain you as a subcontractor and that County Waste reserves the sole and exclusive right to retain any subcontractor or no subcontractors at all for a particular project. TO KNOWINGLY INPUT FALSE INFORMATION, INCLUDING, BUT NOT LIMITED TO NAME, PHONE NUMBER, ADDRESS AND COMPANY DATA IS A VERY SERIOUS AND FRAUDULENT MATTER THAT COULD RESULT IN SIGNIFICANT COSTS AND DAMAGES, AS WELL AS LOSS OF TIME, EFFORT AND EXPENSE, AND ACCORDINGLY, IF YOU PROVIDE FALSE INFORMATION YOU WILL FULLY INDEMNIFY COUNTY WASTE AND BE LIABLE FOR ACTUAL DAMAGES, DIRECT, PUNITIVE AND CONSEQUENTIAL, AND ANY REGULATORY OR JUDICIAL FINES OR PENALTIES THAT MAY ARISE FROM SUCH MISLEADING, HARMFUL AND FRAUDULENT INFORMATION, PLUS REASONABLE LEGAL FEES, COST AND EXPENSES RELATING THERETO.I agree to the terms and conditions above.* NEW USER/COMPANY REGISTRATIONEmail Address*
