AGC of Pennsylvania - Active Membership Application

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application for active membership
908 N. SECOND STREET/Harrisburg, PA 17102/ (717) 232-6071/
Fax (215) 568-3115

Harrisburg, PA 19

to:

Board of Directors
Associated General Contractors of Pennsylvania, Inc.
908 N. Second Street
Harrisburg, PA 17102

Gentlemen:

The following firm

of
Street and number City,State,Zip FAX Number Phone Number

hereby makes application for Active (General Contractor) or (Specialty) membership in your Association and, if accepted, agrees to abide by the Bylaws, rules and regulations thereof and all amendments thereto.

The undersigned further agrees, if accepted, to pay all costs of membership from the date of acceptance of this application to the effective date of its resignation, as prescribed in Article V, Section 8 of the Bylaws, including, but not by way of limitation, membership dues, assessments, and other charges imposed at any time, and authorizes and empowers the Association to collect said costs of membership by legal process, if necessary, in the event of a default in the payment thereof.

This firm is incorporated under the laws of the State of
individually owned business partnership

This firm has been engaged in the construction business since
19

Brief history of the firm and type of work in which engaged. If newly formed, indicate the construction background of principals.

Please list representative commercial, industrial or institutional construction jobs recently performed by the firm as General Contractor.

Owner	Type and Job Location	Architect or Engineer

The firm is a member of the following trade associations:

The following named individuals are authorized to represent the firm in all its relations with the Association:

nametitle

nametitle

Our firm is acquainted with the following Active, Associate or Affiliate members of your organization (name two):

Is your firm a certified minority or women's business enterprise? (MBE/WBE)Yes No

If yes, by what agency(ies) has your firm been certified? (Please check)

The Minority Business Enterprise Council

Pennsylvania Department of Transportation

Other
(please specify)

Very truly yours,

full name of firm

signature and position

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