*Local Union Number           *Email    

Other Trade

*Name of Project

*Location of Project

*General Contractor

Street Address  

Address Line 2  

City State -- AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY BC MB NB NL NT NS NU ON PE QC SK YT AB   Zip  

Country --select-- US CA  

Phone Number () -       Fax  () -      

SubContractor 

Street Address  

Address Line 2  

City State -- AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY BC MB NB NL NT NS NU ON PE QC SK YT AB   Zip  

Country --select-- US CA  

Phone Number () -       Fax  () -      

Subcontractor Rep.

*Please Describe dispute details below 

*Name of Agreement  

Is the contractor stipulated to the plan for settlement of jurisdictional disputes in the constuction industry?

 * required field