RES - Vendor Questionnaire

Submitted

Your information has been submitted to purchase@res.us. Thank you.

General Information

Remittance Information

Sustainability Information

Socioeconomic Statuses

Safety Qualifications

EHS&S Code of Conduct

Signature

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BUSINESS PARTNER & VENDOR QUESTIONNAIRE
RESOURCE ENVIRONMENTAL SOLUTIONS

Required Fields

Required fields are denoted with a red asterisk.

General Information

GENERAL INFORMATION

Are you submitting this for an individual and not an organization?

Email Address of your Contact at RES

First Name

Last Name

Organization Name

DBA

Will your organization perform work at a RES site?

Will your organization deliver any goods to a RES site?

Are you a non-governmental entity or an individual that will be providing services to us?

IRS 1099-Misc Instructions

1099-Misc Exempt Explanation

Description of Products & Services

Tax ID

Currency

Please attach a copy of your Current W-9 form.

Certificate of Insurance

Is Resource Environmental Solutions, LLC the Certificate of Insurance Holder?

Remittance Information

REMITTANCE ADDRESS & CONTACT

Address Line 1

Address Line 2

City

State

Zip

Email

Phone

Fax

ACH PAYMENT INFORMATION

Name on Bank Account

Account Type

Saving

Checking

Bank Name

ABA Routing Number

Account Number

Please attach a bank verification document e.g. void check, letter from the bank, etc.

Sustainability Information

SUSTAINABILITY QUESTIONS

What type of sustainable packaging materials do you use?

Do you have a Green Transportation Plan?

Please explain your green transportation plan.

Socioeconomic Statuses

Registered with sam.gov?

Unique Entity Identification Number

Safety Qualifications

Do you have any questions?

Please contact our EHS&S Department: 1-888-644-5015, Option 1 with questions.

ORGANIZATION’S PROFESSIONAL SAFETY/EHS CONTACT

Does your Organization have a Full-Time Safety Professional?

First Name

Last Name

Email

Phone

How many other full-time safety and health professionals are employed by your Organization?

How often does your EHS representative conduct on- site inspections and toolbox trainings?

Daily

Weekly

Bi-Weekly

Monthly

Quarterly

Annually

Never

SAFETY AND HEALTH PROGRAM

Does your company have workers compensation insurance?

Please submit a copy of your complete written safety or EHS&S plan. If you do not have a written plan, submit a Job Hazard Analysis for the work that you will be performing onsite.

Are injuries, accidents & near-misses investigated by your company?

Does your Organization have a written subcontractor qualification program?

Primary NAICS Code

DRUG FREE WORKPLACE PROGRAM

Does your organization have a written drug free workplace program that includes drug testing requirements?

Does your organization conduct pre-employment drug and alcohol testing.

Does your organization conduct post-accident drug and alcohol testing.

Does your organization conduct reasonable suspicion drug and alcohol testing.

Does your organization conduct random drug and alcohol testing.

FLEET & DOT PROGRAM

What is your organization’s DOT #? (If Applicable)

WORKERS’ COMPENSATION EXPERIENCE MODIFICATION RATE

List your Organization’s Workers’ Compensation Experience Modification Rate (EMR) for each of the last 3 years.

If most recent year has a rate greater than 1.00, please explain.

ORGANIZATION'S TOTAL RECORDABLE INCIDENT RATE

If applicable, please list your Organization’s Total Recordable Incident Rate for each of the last 3 years.

If most recent year has a rate greater than 2.00, please explain.

ACCIDENT AND ILLNESS STATISTICS

Please submit a copy of your OSHA 300 and 300A logs for the last 3 years.

OSHA CITATIONS

Has your organization received any Federal or State OSHA citations within the last 3 years?

Please attach a copy of your citations.

Please give a brief description of the nature of the citation(s), or attach a copy of the citation(s).

EHS&S Code of Conduct

Download Code of Conduct

Signature

SIGN ABOVE

Full Name

Title

Email

Date

Submit

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