Crane Owner Application Form Crane Owner Application Form Organization Information Organization Name Phone Street Address City State Postal/Zip Code Website Contact Information Main Contact Name Main Contact Phone Main Contact Email Accounts Payable Contact Name Accounts Payable Phone Accounts Payable Email Accounts Receivable Contact Name Accounts Receivable Phone Accounts Receivable Email Officers President Name Length of time in position Vice President Name Length of time in position Treasurer Name Length of time in position How many years has your organization been under your present firm's name? Parent Firm Information (if applicable) Parent Firm Name Parent Firm Street Address City State Postal/Zip Code Subsidiaries Under current management since (mm/dd/yyyy) Licensing Please indicate if your business qualifies as one or more of the following: Minority Business Enterprise (MBE) Select an option Yes No Disadvantaged Business Enterprise (DBE) Select an option Yes No Small Business Enterprise (SBE) Select an option Yes No Women’s Business Enterprise (WBE) Select an option Yes No Type of License and State License Number Work Experience Average Project Size ($) Largest project ever completed ($) Year largest project was completed How many years has your organization been in business under your present firm's name? Major projects completed in the last three years (Project Name, Location, Owner, Contract Amount, Completion Date, Contact Person with Phone Number) Please provide all trade and professional licenses required for your services. Work Experience Con't Has your firm or any related organization failed to complete work awarded in the last three years? Select an option Yes No Are there any judgments, claims, arbitration proceedings, or suits pending/outstanding against your firm or its officers? Select an option Yes No Has your firm filed any lawsuits or requested arbitration with regard to construction contracts within the last three years? Select an option Yes No Has any license ever been denied or revoked? Select an option Yes No Has a complaint ever been filed with a Contractor's State License Board against your firm? Select an option Yes No Has your firm or any related organization been in bankruptcy or engaged in reorganization within the last three years? Select an option Yes No Do you prepare lift plans? If so, please describe the process or provide an example. Insurance Information Insurance Agency Contact Person Phone Email Safety Coordinator - Highest Ranking in the Company Name of Safety Coordinator Title Phone Number Email Certifications related to Safety (e.g., OSHA 30-hour, CSP) Frequency of Safety Meetings (e.g., weekly, monthly) Do you conduct incident reviews and root cause analyses? Select an option Yes No Safety and Health Information Who is your safety manager or person responsible for safety and health? Safety Manager Phone Number Safety Manager Email Have you had any OSHA violations in the last 3 years? Select an option Yes No If yes, please provide details: Do you have a written safety program? Select an option Yes No Do you conduct regular safety training for your employees? Select an option Yes No Do you have a drug testing policy? Select an option Yes No Do you have an emergency response plan? Select an option Yes No Have you received any safety or health recognition awards in the last 3 years? Select an option Yes No Submit Application
