Staley Partner Qualification Webform

Fill out the form below to see if you qualify to become a Staley Partner. All fields are required for submission.

Company Name

Contact Person

Address

City

State

Zip

Telephone

After Hours Contact Number

Email Address

Email Address for Service Request

Federal ID

Does your company have a current Safety Plan?

Has your firm had any OSHA citations, fines, or jobsite violations within the most recent three (3) years?

Customers may require that we be certified in the use of a lift and to have that certification on lifts. Do your electricians and/or technicians possess any lift certifications? (i.e. scissor lifts, boom lifts. Etc.)

Please list all states and counties in which you work. Please Be Specific

Union Company

Year Business Started

Are you able to provide a certificate of insurance (COI) indicating coverage amounts of $1M in worker’s compensation and a general aggregate of $2M in G/L?

Do you hold a state or city (county) electrical or low voltage license?

Number of Full Time Employees

Number of Techs

Number of Electricians

All Staley partners are required to perform drug testing and background checks. Does your company do a pre-employment background check?

Do you require drug testing for employees?

Do you have BICSI certified techs?

What is your main line of work (Data, telecom, electrical)?

What fields do you cover (fiber, cat5e, cat6, electrical, etc.)?

Number of Company Owned Vehicles

Do you have a 24x7x365 Service Group?

Do you have Trained Fiber Optic Technicians?

Do you have CAT5e & CAT6 Testers?

If Yes - What Kind?

Do you have Fiber Testers?

Can Field Technicians Bend Pipe?

Machine Generated Labeler?

Do you have experience with phone switches?

Do you have experience with data switches?

Do you have experience with security or CCTV?

Do you have experience with wireless (installations, coverage surveys, etc.)?

Do you have any experience in Access Control (wiring, devices, programming, etc.)?

Are there any judgments, claims, arbitration proceedings, or suits pending/out-standing against your firm or Its officer or principals?

Has your company filed any lawsuits or requested arbitration or mediation with regard to installation contracts within the last three (3) years?

Has your company or any of its Owners declared Bankruptcy in last 5 years?

Is your company owned or controlled by a parent or any other organization?

Was there ever a project that you were not able to complete by the required deadline?

Project Details

Provide details below about the 2 largest projects completed in the last 12 months.

PROJECT 1

Project Name

Company

Telephone

Address

Your Contract Amount

PROJECT 2

Project Name

Company

Telephone

Address

Your Contract Amount

Rates

Electrician Hourly Rate

Data Technician Hourly Rate

Security Technician Rate

Overtime Rate

Typical Material Mark-Up

Per Diem Rate

Do you have a minimum hour policy?

Hotel Rate

Hourly Travel Rate

(or) Mileage Rate

How did you hear about us?

How did you hear about Staley Technologies?

Name

Title

Date

Staley Partner Qualification Webform

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Project Details

Rates

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