Fire Safe Vendor List Application "*" indicates required fields Step 1 of 4 25% 1. Vendor InformationBusiness Name*Sales Contact*This should be your sales representative and will be added to your listing if approved. First Last Contact Title*Contact Phone*Contact Email* Enter Email Confirm Email Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Website*Social Media URLsIf applicable, please add your company social media URLs and handles below. You can add up to 10 rows.Account URLAccount Handle Add RemoveYears in business* 2. Vendor Type and Area of ExpertiseType of Vendor*Select up to two vendor types if you are unsure of the category you fit in or if your product and/or service covers more than one type. Fire Resistant Building and Materials (contractors, siding, vents, gutters, screens, etc.) Wildfire Mitigation Platforms and Services (assessment apps, data tracking, and services such as chippers, tree trimmers, mastication, grazing, traffic control, etc.) Environmental Consultants (CEQA compliance, biological surveys, CWPPs, grant writing, forestry, etc.) Fire Detection Software, Equipment, & Services (sensors, cameras, drones, satellites, AI, and platforms) Emergency Response Equipment (sprinklers, alarms, sirens, disaster plan apps, etc.) Are you a contractor?* Yes No If yes, what is your contractor License Number*Contractor Type*Are you a small business or non-profit organization? Businesses with annual revenue of $1,000,000 or less qualify for a 50% discount on the listing option of their choice. Non-profit organizations also qualify for a 50% discount on the listing option of their choice.* Yes No If yes, please upload your most recent completed tax return (businesses) or your tax exemption letter (non-profits) to qualify for the discount.*Accepted file types: pdf, Max. file size: 2 MB.Please include a 10-words or less list of services and/or products offered below.*If you are approved, this statement will go in your listing.Please include a 50-word or less statement that highlights what your business offers.*This is your promotional statement that can include more information on your business such as product/service results and/or guarantees, or other information that distinguishes you. If you are approved, this statement will go in your listing.What geographical area do you serve?*Select all that apply. To make multiple selections, hold the CTRL key (or the CMD key if using a Mac computer).StatewideAlameda CountyAlpine CountyAmador CountyButte CountyCalaveras CountyColusa CountyContra Costa CountyDel Norte CountyEl Dorado CountyFresno CountyGlenn CountyHumboldt CountyImperial CountyInyo CountyKern CountyKings CountyLake CountyLassen CountyLos Angeles CountyMadera CountyMarin CountyMariposa CountyMendocino CountyMerced CountyModoc CountyMono CountyMonterey CountyNapa CountyNevada CountyOrange CountyPlacer CountyPlumas CountyRiverside CountySacramento CountySan Benito CountySan Bernardino CountySan Diego CountySan Francisco CountySan Joaquin CountySan Luis Obispo CountySan Mateo CountySanta Barbara CountySanta Clara CountySanta Cruz CountyShasta CountySierra CountySiskiyou CountySolano CountySonoma CountyStanislaus CountySutter CountyTehama CountyTrinity CountyTulare CountyTuolumne CountyVentura CountyYolo CountyYuba CountyPlease check all that apply Employee-owned business Micro-business (9 employees or fewer) Minority-owned business Small business (500 employees or fewer) Veteran-owned business Women-owned business Select AllWho is your primary market right now?*Are you looking to get into other markets?* Yes No If so, which ones?*Do you have experience working with Fire Safe Councils and/or grant funded projects?* Yes No If so, which ones?* 3. Compliance and CertificationProof of Liability Insurance with California Fire Safe Council as an additional insured*Please upload your certificate of insurance with California Fire Safe Council added as an additional insured. If your carrier requires it, our address is 3237 Peacekeeper Way, Suite 201, McClellan, CA 95652Accepted file types: pdf, Max. file size: 2 MB.Proof of Workers' Compensation*Please upload your current certificate of Workers' Compensation Insurance. If it is included with your certificate of insurance above, please upload it again. If you are a sole proprietor, please upload a document on company letterhead stating that as a sole proprietor, you are exempt from needing workers' compensation insurance.Accepted file types: pdf, Max. file size: 2 MB.Business License*Please upload your current business license.Accepted file types: pdf, Max. file size: 2 MB.Has your organization been suspended or debarred from receiving federal funds or contracts?* Yes No What is your Unique Entity Identification (UEI) number, if you have one?If you haven't already, please fill out AD-1048 and upload.Download AD-1048Accepted file types: pdf, Max. file size: 2 MB.Environmental Responsibility and CertificationsPlease provide your environmental responsibility statement, if you have one, and mention any environmental certifications you have. Please also mention any additional certifications you have (such as IBHS for home materials).ReferencesPlease provide up to three references for clients or partners who can vouch for your performance. Recommendations from government agencies and Resource Conservation Districts are helpful. Feel free to add notes about specific jobs, services, and/or products you provide.Reference*You can add up to 3 rows.Name/Org(s)EmailPhoneNotes Add RemoveAlignment with CFSC*Please provide a statement of alignment with CFSC's mission. (This will not be included in your listing.) 4. Declaration and SignatureI, the undersigned, declare that the information provided in this application is true and accurate to the best of my knowledge. I understand that the submission of false or misleading information may result in the denial of my application for inclusion on CFSC’s Fire Safe Vendors List.Vendor Representative's Full Name*Date* MM slash DD slash YYYY Δ
