Form Pwc-100 - Contractor Dir Registration Verification Data Form printable pdf download

Form Pwc-100 - Contractor Dir Registration Verification Data Form

PWC- 100 Contractor DIR Registration Verification Data Form

Important Notice: Beginning January 1, 2015: (a) No contractor or subcontractor may be listed on a bid proposal for a public

works project (submitted on or after March 1, 2015) unless registered with the Department of Industrial Relations pursuant to

Labor Code section 1725.5; (b) No contractor or subcontractor may be awarded a contract for public work on a public works

project (awarded on or after April 1, 2015) unless registered with the Department of Industrial Relations pursuant to Labor Code

section 1725.5; and (c) All projects are subject to compliance monitoring and enforcement by the Department of Industrial

Relations.

All contractors and subcontractors who bid on work on a public works project must register and pay an annual fee to DIR.

Contractors may register at:

https://efiling.dir.ca.gov/PWCR/ActionServlet?action=displayPWVRegistrationForm

This form serves as your verification that you have met the above requirement and are able to bid on public works projects with

Oxnard Union High School District. Failure to provide this form will result in discontinuation of services with your company.

Please type or print legibly

All fields must be filled out by Contractors

Company Name: ___________________________________________

Contact Name: _____________________________

Address: ____________________________________

City: ___________________

State: ________

Zip: ____________

Phone No. (

) _______________________

Fax No. (

) _______________________

Contractor’s Lic. No.: _______________

Class Type: ____________________

DIR Registration No.:__________________

E-mail address: ___________________________________

(Email address must be the same account your company submitted for DIR

registration)

DIR Classification of workers to be utilized: _____________________________________________________________

Will Sub-Contractors be utilized: Yes

(if so, you must provide the work classifications on page 2 and

company information on page 3 as needed)

Prevailing wage applies on projects that meet or exceeds $1,000. Proof of valid Contractor/Specialty license, DIR Registration,

workers compensation and insurance are required before work starts.

***Please mail original form back to the Oxnard Union High School District Purchasing Department, Attn: Deanna

. ***

Rantz at 309 South K Street, Oxnard, CA 93030 or email to

Deanna.Rantz@ouhsd.k12.ca.us

1 |

P a g e

PWC-100 Form Revised 1/15

Form Pwc-100 - Contractor Dir Registration Verification Data Form