AISC Certification Application: Fabricator Program

For first time applicants and currently certified facilities wishing to change their certification status.

REQUIRED
Company Name AISC Member #
(if applicable)
Facility Name Total employees
This distinction helps us differentiate between multiple facilities operating under a single company name. at facility

Primary Facility Address Current Certifications Requested Certifications

not currently certified
address (1) Building Building
address (2) Simple Bridge Simple Bridge
Major Bridge Major Bridge
city, state, zip Bridge Component Standard Bridge Component Standard
Paint Endorsement - enclosed Paint Endorsement - enclosed
country Paint Endorsement - covered Paint Endorsement - covered
Paint Endorsement - exposed Paint Endorsement - exposed
Secondary Facility Address Fracture Critical Endorsement Fracture Critical Endorsement
(Applicable only for facilities whose support functions, such as management,
detailing, purchasing, etc. have a different address.) Certification Contact
(Person who oversees the certification effort for the facility)
Distance in miles from ‘Primary’
name
address (1) title
address (2) email
city, state, zip phone fax
country alternate contact person

Mailing Address Principle Officer

(If different from Primary Facility Address) (Highest ranking officer at the facility, if different than Certification Contact)

address (1) name

address (2) title
city, state, zip email
country phone

Authorized Signature Title

(Certification Contact or Principal Officer)

Print Name Date

OPTIONAL This information will be posted at www.aisc.org upon successful completion of certification process.
Marketing Contact Name Company Website
email phone

Please mark the AL CO GA IA MD MO NJ OH SC VT WY

boxes which AK CT HI KS MA MT NM OK SD VA
represent the states AZ DE ID KY MI NE NY OR TN WA
in which you
AR DC IL LA MN NV NC PA TX WV
conduct regular
business. CA FL IN ME MS NH ND RI UT WI

Please mark the box that represents the percentage of contracts your facility receives on an annual basis that specify an AISC Certified Company.
< 10% 10 - 25% 26 - 50% 51 - 75% > 75%

Apply Today! Mail or fax APPLICATION to: Mail PAYMENT to:

Quality Management Company, LLC American Institute of Steel Construction, Inc.
1 E. Wacker Dr., Suite 700 5109 Eagle Way
Chicago, IL 60601 Chicago, IL 60678-1051
fax: 312.896.9202 Overnight payment to: JPMorgan, Attn: AISC 5109,
131 S. Dearborn 6th Fl, Chicago, IL 60603
Please make check payable to AISC.
AISCQC021 March 15, 2010