Subcontractor Application – Collins Land Services, LLC

The following information is required in order to process payments for invoices from subcontractors. On certain jobs a subcontractor contract might be required, and payment will not be issued until it is confirmed that all work is completed to spec. If wire transfer is requested there will be a $45.00 processing fee subtracted from the payment. No payments will be made by check, credit card or wire until all information is provided.

Subcontractor Information

FDOT Contract Number(Required)

CLS Point of Contact

Company Name(Required)

Contact Name:(Required)

Phone(Required)

Email(Required)

Accounts Receivable Contact:(Required)

Accounts Receivable Phone:(Required)

Accounts Receivable Email:(Required)

Company Address (Mailing)(Required)

Street Address Address Line 2 City State ZIP Code

Required Form Uploads

All forms MUST be completed in their entirety and submitted below prior to issuance of payment.

Current Certificate of Insurance(Required)

Max. file size: 50 MB.

Address listed on COI should read: COLLINS LAND SERVICES INC. P.O. Box 217 Havana Fl, 32333 (must be marked additionally insured)

Current Workers Comp or Workers Comp Exemption Form(Required)

Max. file size: 50 MB.

Current Year W9(Required)

Max. file size: 50 MB.

Florida Subcontractor Legal Employees Affidavit(Required)

Accepted file types: pdf, Max. file size: 50 MB.

Download form below, complete, then upload here.

Labor Affidavit Blank – Subcontractors Download