DESCRIPTION

YES

NO

ADDITIONAL COMMENTS

FEDERAL (US DOL) CERTIFICATE OF REGISTRATION

Received copy from FLC?

REG #:

Verified Registration with DOL

EXP DATE:

Certificate of Registration for FLC Employee(s) on file?*

*Company name printed on Certificate should correspond to FLC

Transportation Authorized?

If transportation authorized:

Vehicle Mechanical Inspection Form WH-514 on  
     file for each driver

Medical Certificate for each driver on file?

HP Farm Labor Vehicle drivers have Class B license
     with Farm Labor Vehicle endorsement?

Driver licenses on each of the FLC's drivers on file?

Liability Insurance Policy

Housing Authorized?

If housing authorized-housing permits & current
     inspections reports on file?

Provides MSPA disclosure statement?

TAX STATUS

Registered with Internal Revenue Service (IRS)

FLC's tax status is clear?

Registered with the state’s Franchise Tax Board?

WORKERS' COMPENSATION INSURANCE

A current Certificate of Insurance is on file?

DESCRIPTION

YES

NO

ADDITIONAL COMMENTS

OTHER SUPERVISOR/EMPLOYEE TRAINING

First Aid/CPR current training certificates?

Equipment Safety Training (if applicable)?

POSTINGS

Current Federal postings are displayed including MSPA poster?

Current State postings are displayed?

FLC/COMPANY AGREEMENT COMPONENTS

Agreement has been signed by both parties?

Amount: $

Secure comprehensive General Liability Insurance and list company as an additional insured?

Agreed to indemnify and hold harmless clause?

Agreed to binding arbitration?

Will provide payroll information with each invoice?

Will provide evidence of state/federal employment tax payments?

Will maintain USCIS Form I-9 on all employees?

Will allow company to inspect related employment documents?

Subcontracting prohibited without grower consent and documentation of registration, licensing, and compliance by subcontractor?