Contractor Registration
Company Information
Company Name & DBA *
Federal EIN / Tax ID *
Business Address *
Contact Information
Primary Contact - Name *
Primary Contact - Phone *
Primary Contact - Email *
Secondary Contact
Services
Service Categories *
Debris Management
Temporary Facilities
Electrical
Plumbing
Heavy Equipment
Other
Crew Size Available Day 1 *
Equipment Inventory
Certifications
Certifications Held
OSHA 30
HAZWOPER
MSHA
CDL
Other
Active Licenses & Insurance *
Upload General Liability & Workers Comp documentation (PDF/JPG)
Insurance Expiration Date *
Coverage and Availability
Coverage Area Radius (mi) *
Available Start Date *
Daily Start Time *
Daily End Time *
Additional Information
Haz-Mat Capability *
Yes
No
Prior FEMA Experience *
Select experience level
Agree to Background Check *
Yes
No
Digital Signature
Digital Signature *
Clear Signature
Please provide your signature
Submit Registration
