Subcontractor Onboarding Form

Company Name:*

Primary Contact Name:*

Email Address:*

Phone Number:*

Business Address:*

Website

Upload Required Documents Here (Please attach — Insurance Is Mandatory):*

-IRS W-9 Form (signed and dated) ________________ -Certificate of Insurance (COI)_________________ Must include:___________________________________ • General Liability (Required)_____________________ • Workers’ Compensation (Required)_______________ • Auto Insurance (Required if applicable to your scope of work)_______________________________________ • Name LSWORKS LLC, 14310 Jefferson Ave, Orland Park, IL 60462 as:___________________________________________ o Certificate Holder______________________________ o Additional Insured_____________________________ o Contractor License(s) (if applicable)

Payment Information:*

(Select one)

Check

ACH Transfer (Direct Deposit) — Business Checking Accounts Only

If ACH Transfer is selected, please provide the following: (If Check - Type N/A)*

Bank Name • Routing Number• Account Number • Account Type (Business Checking Only) • Payable Contact (if different) • Payable Email

Payment Terms*

Type of Trade / Scope of Work:*

License # (if applicable)

Federal Tax ID / EIN:*

Business Structure:*

Corp/LLC/Sole Proprietorship/Other(Please List)

Number of Employees:*

Labor Structure:*

Union

Non-Union

Emergency Contact:*

Please List: Name - Phone Number - Relationship/Role

W-9:*

Please select Yes/No if you have a W9 to provide. You may upload a copy of it below.

Yes

COI-General (Certificate of Insurance):*

Please select Yes/No if you have a COI-General Form to provide. You may upload a copy of it below.

Yes

COI General Expires:

Please enter the COI General expiration date.

COI-Workers Comp (Workers Compensation):*

Please select Yes/No if you have a COI-Workers Comp Form to provide. You may upload a copy of it below.

Yes

COI Workers Comp Expires:

Please enter the COI Workers Comp expiration date.

COI-Auto Insurance: (If Applicable)

Please select Yes/No if you have a COI-Auto Form to provide. You may upload a copy of it below.

Yes

COI Auto Expires: (If Applicable)

Please enter the COI Auto expiration date.

Authorization:*

I certify that the information provided is true and complete to the best of my knowledge. I authorize LSWORKS LLC to use this information for business and payment purposes, including processing payments via ACH transfer to my business checking account if that payment method is selected.

Yes

Notes:

Please provide any additional information you may want to share with us about your company.