Vendor Application - Installers & Manufacturers

Vendor Application - Installers & Manufacturers

Please fill out all the applicable information below. If not applicable mark N/A.

If different than above, provide billing information below.

Bill To Address Line 1

Bill To Address Line 2

Bill To City

Bill To State Code

Select or enter value

Bill To Zip Code

Contact Name*

Phone Number*

Fax Number

Contact Email Address*

Website*

EIN*

Minority Owned*

If yes, please attach a certificate

Select or enter value

Women Owned*

If yes, please attach a certificate

Select or enter value

Vendor Type*

Please select a vendor type from the list below to identify your primary capabilities. Our team will use this internally when sourcing vendors.

INMF - Install and Manufacture

Compliance

Section 2 of 4

Does your company have a contractors license?*

Yes

If so, is it held by the company or individual?

Company

Individual

License type

License #

Exp. Date

Do you have any additional licenses [Master Electrician, Electrical Contractor, Other]

What welding certifications are held by your company?

Note: You will need to provide a copy of the welding certification for each certified employee. You will also need to provide copies of all licenses for all individual employees and for all governing entities.

List any Union affiliations

Exp. Date

Have you had any OSHA violations in the past 5 years?*

Yes

If yes, please explain

Insurance Coverage- Please attach or forward a copy of your insurance certificate

Cima's requirements are: 1. Commercial general liability $1,000,000 2. Automobile liability $1,000,000 3. Workers comp $500,000 You must provide a certificate of insurance that shows an additional insured as Cima Network Inc. The certificate must have a cancellation clause of 30 days minimum notice.

Does your firm have any current or pending litigation/arbitration with past or present clients or subcontracotrs?*

Yes

If yes, please explain

Within the past 5 years has any officer or principal in your organization ever been an officer or principal of another corporation when it failed to complete a sign contract?*

Yes

If yes, please explain

Has your company or any of its principals ever petitioned for bankruptcy, failed in business, defaulted and/or terminated on a contract awarded to you?*

Yes

If yes, please explain

Capabilities

Section 3 of 4

Select all applicable capabilities. If not applicable mark N/A.

Surveys*

Yes

Permitting*

Yes

Service*

Yes

Installation*

Yes

Electrical*

Yes

Service Labor Rates:

Labor per hour - 1 man Service Truck up to 50' [$]*

Labor per hour - 2 men Service Truck up to 50' [$]*

Labor per hour - 2 men Crane Truck 50'-85' [$]*

Labor per hour - 2 men Crane Truck 85'+ [$]*

Emergency Hourly Rate [$]*

CIMA CONTACT - How did you hear about us?*

Select or enter value

Non-Compete/COI and W9

Section 4 of 4

Subcontractor Non-Compete*

By checking the box below you are agreeing to the following: This agreement is made as of the date of the last signature below by and between Cima Network, Inc. having principal offices at 121 New Britain Blvd., Chalfont, PA 18914, and ("Subcontractor") As your vendor name and address is stated in Section 1 "Company Information" section. Per this agreement, Subcontractor agrees that for so long as Subcontractor shall remain engaged by Cima Network, Inc. as a subcontractor for a period of (5) years after termination of engagement with Cima Network, Inc. for any reason (to be known as the "Non-Compete Period"), Subcontractor shall not directly or indirectly solicit the business of servicing or supporting Cima Network, Inc. signs/products from a Cima Network, Inc. customer or client, nor engage in (as an employee, principal, shareholder or partner, consultant or any other capacity) any enterprise conducting business activities directly or indirectly with a Cima Network, Inc. customer or client to the extent that said business activities are related to servicing or supporting Cima Network, Inc. customer or client to the extent that said business activities are related to servicing or supporting Cima Network, Inc. equipment, nor directly or indirectly solicit Cima Network, Inc employees for employment. Engagement is at will for both parties and may be terminated by either party upon written notification to the other party.

Non Compete Signature*

Signature Date*

Submit COI, W9 and Subcontractor Agreement

You must also submit a current COI and W9 with this application, along with the Subcontractor Agreement provided by the Project Manager. If you did not receive the Subcontractor Agreement please indicate that in the "Additional Info" field in Section 5. Please either attach the required documents below or send via email to ap@cimanetwork.com. If you are attaching the documents please check the box in its respective field.

COI attached

W-9 or W-8 BEN (International Vendors Only)attached

Subcontractor Agreement Included

Please download the form INSTALLERS ONLY - MASTER SUBCONTRACT AGREEMENT, provided by the Project Manager or Service Coordinator or from our website under Contact Us.

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