Contractor Nomination Form 2025

Application Deadline: February 28, 2025
Awards Banquet Date: May 8, 2025

Contact Information
Your Name: Your Name: First Last
Your Email Address:
Your Phone Number: Your Phone Number: - ### - ### ####
Terms and Conditions:

You (the “Submitter”) certify that all submitted information in this application is true and correct to the best of your knowledge. Upon completion, GCSC will present this application to the designated Owner Representative for approval/denial.
By clicking 'Yes' you understand and agree with the terms and conditions above?

By clicking 'Yes' you understand and agree with the terms and conditions above? Yes
Company Information
Company Name:
(exactly as you wish it to appear on all printed material)
Company Address: Company Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Type of Business, Work, Service:
Multiple Location Award:
Plant Information
Owner Name
Owner Representative Name: Owner Representative Name: First Last
Phone Number: Phone Number: - ### - ### ####
Email Address:
Contractor Statistics
Total Site Hours Worked in 2024:

Ex: 2000, 25000, 100000
Fatalities in 2024:
Lost Work Day Cases in 2024:
Recordable Cases in 2024:
OSHA Citations in 2024:
Required Attachments

Please include your company name in the original filenames before submitting.

If you have trouble uploading pictures, please email them to kayla@mygcsc.com.
Please upload 3 work activity photos.

Attach Files
Please upload Company Logo.

Attach Files
General Synopsis of Safety Management Program and Policies/Procedures (limit to 5 pages)

Attach Files
Innovative Award

The Award for Innovations in Safety recognizes those who have developed and implemented innovative safety solutions in the workplace.
What innovative process, program, or device has your company developed and initiated in the past year? This is your opportunity to demonstrate that "special something" that sets your company apart from the others.

If you choose 'Yes' below, you will be required to submit an Innovative Award Nomination Form.
My company would like to be considered for the Award for Innovations in Safety.

My company would like to be considered for the Award for Innovations in Safety. Yes No
Sponsorship
Please include our company as a sponsor for the following:

Sponsorship does not include table.

Deadline for submitting Ad information is March 28, 2025.
Please select your method of payment:
I would like to...

A convenience fee of 3% will be charged on all card payments.
PO #
Cardholder Name (as shown on card):
Card Type:
Other:
Card Number:
Security Code:
Expiration: Expiration: / MM / DD YYYY
Email Receipt to:
Billing Address

Billing Address Same as above
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Authorized Amount: $ Dollars . Cents
A convenience fee of 3% will be charged on all card payments.
I certify that I am the authorized holder and signer of the credit card referenced above. I certify that all information above is complete and accurate. I hereby authorized collection of payment for all charges as indicated above. Charges may not exceed the amount listed above in the "Authorized Amount" field. If additional charges are going to be authorized a new form will have to be completed.
Authorization of Card Use

Authorization of Card Use I agree
Cardholder Signature:

Draw or Type

Clear

Full Name
Verification of Information

Verification of Information I hereby certify that all information submitted in this application is true and correct to the best of my knowledge.
Confirmation:

Confirmation: I understand that I will receive a confirmation email upon submittal.

Contractor Nomination Form 2025

Contractor Nomination Form 2025

Contact Information

Terms and Conditions:

Company Information

Plant Information

Contractor Statistics

Required Attachments

Innovative Award

Sponsorship

Please select your method of payment: