Firm Name: UBI Number: Contact: Day Phone Number: Night Phone Number: Fax: Email: Website: Status Address: Line 2: City: State: Zip:

Remit Address (if different)

Line 1: Line 2: Categories:

My firm wishes to be added to the small work roster for the categories as indicated by the boxes I have checked above.

I understand that to remain on the Small Work Roster, my firm must respond to every Invitation to Bid (ITB); with, at minimum, a written "no bid" response, otherwise I will be deleted from the roster.

I further understand that it is my firm's responsibility to keep abreast of current requirements and notices posted to the Kittitas County Small Work website regarding the Small Work Rosters and Kittitas County is not responsible for communicating changes or amended requirements by the State to the firm.

Submitted by: Title: Date:

This list of rosters may be revised at any time by Kittitas County, without notice to vendors.