General Company Information
TYPE OF WORK / SERVICE
*
COMPANY LEGAL NAME
*
ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PHONE NUMBER
*
Please enter a valid phone number.
WEBSITE
YEARS IN BUSINESS (UNDER CURRENT NAME)
*
PHOTOS OF WORK (optional)
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TYPE OF COMPANY
*
Corporation
Partnership
Sole Proprietorship
LLC
TYPE OF BUSINESS
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Architect
Engineer
Subcontractor
Supplier
Designer
Other
NUMBER OF OWNERS, PRINCIPALS, OR PARTNERS
*
NUMBER OF EMPLOYEES
OFFICE PERSONNEL
*
FIELD SUPERVISORS
*
FIELD LABOR
*
CONTRACTOR'S LICENSE NUMBER
*
COMPANY OR OWNER BANKRUPTCY IN THE LAST 5 YEARS?
*
Yes (please explain)
No
COMPANY OR OWNER BANKRUPTCY IN THE LAST 5 YEARS? PLEASE EXPLAIN
*
ESTIMATING CONTACT(S) INFORMATION
ESTIMATING CONTACT 1
NAME
*
First Name
Last Name
PHONE NUMBER
*
Please enter a valid phone number.
EMAIL
*
example@example.com
ESTIMATING CONTACT 2
NAME
First Name
Last Name
PHONE NUMBER
Please enter a valid phone number.
EMAIL
example@example.com
PROJECT INFORMATION
PROJECT CONTRACT RANGE
*
ANNUAL VOLUME ($)
*
HAS THE COMPANY EVER DEFAULTED ON A PROJECT?
*
Yes (Please Explain)
No
HAS THE COMPANY EVER DEFAULTED ON A PROJECT? PLEASE EXPLAIN
RECENT PROJECTS YOU HAVE COMPLETED
*
LIST GENERAL CONTRACTORS YOU HAVE PREVIOUSLY WORKED WITH:
*
INSURANCE / WORKERS COMPENSATION INFORMATION
INSURANCE COMPANY
*
ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
BROKER AGENT NAME
*
AGENT PHONE NUMBER
*
GL LIMITS: SINGLE PROJECT
*
GL LIMITS: AGGREGATE
*
WORKERS COMPENSATION INSURANCE
INSURANCE COMPANY
*
ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
BROKER AGENTS NAME
*
AGENT PHONE NUMBER
*
LIMITS: SINGLE PROJECT
*
LIMITS: AGGREGATE
*
LEGAL INFORMATION
ARE THERE ANY JUDGMENTS, CLAIMS, ARBITRATION PROCEEDINGS, OR SUITS PENDING / OUTSTANDING AGAINST YOUR FIRM OR ITS OFFICER OR PRINCIPALS?
*
Yes (Please Explain)
No
ARE THERE ANY JUDGMENTS, CLAIMS, ARBITRATION PROCEEDINGS, OR SUITS PENDING / OUTSTANDING AGAINST YOUR FIRM OR ITS OFFICER OR PRINCIPALS? PLEASE EXPLAIN
*
HAS YOUR COMPANY BEEN INVOLVED IN ANY LAWSUITS, ARBITRATION OR MEDIATION WITH REGARD TO CONSTRUCTION CONTRACTS WITHIN THE LAST (5) YEARS?
*
Yes (Please Explain)
No
HAS YOUR COMPANY BEEN INVOLVED IN ANY LAWSUITS, ARBITRATION OR MEDIATION WITH REGARD TO CONSTRUCTION CONTRACTS WITHIN THE LAST (5) YEARS? PLEASE EXPLAIN
*
CONSENT
*
By clicking "submit," I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge and belief.
Please verify that you are human
*
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