Contractor/Vendor Pre-Qualification Form (PQF)

Contractor/Vendor Pre-Qualification Form (PQF)
GENERAL INFORMATION
1.
Telephone
Fax
2.
Title
Telephone
Fax
3.
4.

Form of Business: Sole OwnerPartnershipCorporationJoint Venture
Partnership
Is your company a subsidiary of another company? If yes, name of Company
Is your business a division of another company? If yes, name of Company
Is your business franchised by another company? If yes, name of Company
Has your company engaged in business with CenterPoint Energy within the last 12 months? If yes, name of CNP location where you are doing business
Are you an employee or relative of an employee of CenterPoint Energy?
If yes, explain
Business Classification Definitions
Minority Business Enterprise (MBE) -- A minority-owned business, as used in this form, refers to a business that is at least 51- percent owned by one or more minorities, and whose management and daily business operations are controlled by one or more minorities. Asian-Indian -- A U.S. citizen whose origins are from India, Pakistan and Bangladesh. Asian-Pacific -- A U.S. citizen whose origins are from Japan, China, Taiwan, Korea, Vietnam, Laos, Cambodia, the Philippines, Samoa, Guam, the U.S. Trust Territories of the Pacific or the Northern Marianas. African-American -- A U.S. citizen having origins in any of the Black racial groups of Africa. Hispanic -- A U.S. citizen of true-born Hispanic heritage, from any of the Spanish-speaking areas of Latin America or the following regions: Mexico, Central America, South America, and the Caribbean Basin only. Native American -- A person who is an American Indian, Eskimo, Aleut, or Native Hawaiian, and regarded as such by the community of which the person claims to be a part. Native Americans must be documented members of a North American tribe, band or otherwise organized group of native people who are indigenous to the continental United States and proof can be provided through a Native American Blood Degree Certificate (i.e., tribal registry letter, tribal roll register number Small Disadvantaged Business (SDB) -- A small disadvantaged business, as used in this document, refers to a small business 1) that is at least 51-percent owned by one or more individuals who are both socially and economically disadvantaged, or a publicly-owned business whose stock is at least 51-percent owned by one or more socially and economically disadvantaged individuals and 2) whose management and daily business operations are controlled by one or more such individuals. Women Business Enterprise (WBE) -- A women-owned business, as used in this form, refers to a business that is at least 51- percent owned by one or more women, and whose management and daily business operations are controlled by one or more minorities.
5. Business Classification Is your business currently certified as a Minority-Owned Business by any government agency or

purchasing council? YesNo
If yes, please identify from previous list:

Certification Number:

Expiration Date:
Certification Agency:
Certification Number:
Epiration Date:
Is your business currently certified as a Women-Owned Business by any government agency or

purchasing council? YesNo
Certification Number:

Expiration Date:
Certifying Agency:
Certification Number:
Expiration Date
Is your business currently certified as a Small Disadvantaged Business by any government agency or

purchasing council? YesNo
6.
How many years has your organization been in business under your present firm name?
7.
Contact for Insurance Information:
Title
Telephone
Fax
If service provider, Please attached a copy of your current ACORD Agreement
9.

Are you self insured for Worker’s Compensation Insurance? YesNo
Are you self insured for Worker’s Compensation Insurance? Yes
10.
General Information PQF Completed By:
Title
Telephone
Fax
FINANCIAL INFORMATION

Size

	Type of Work/Material	$M	Customer Contact	Telephone	Customer/Location

12. Are you now or have you ever been involved in any bankruptcy or reorganization proceedings?
If yes, please attach details.

YesNo
13. Are you subject to liquidation or debt reduction procedures under state law?
If yes, please attach details.

YesNo
14. Are you subject to pending liquidation or regulatory proceedings in state or federal courts which could cause a substantial deterioration of your financial condition?
If yes, please attach details.

YesNo
15. Are you subject to any significant collection lawsuits or outstanding judgments which would significantly affect your ability to remain solvent?
If yes, please attach details.

YesNo
16. Are there any overdue amounts owed to any division or subsidiary of CenterPoint Energy, Incorporated?
If yes, please attach details.

YesNo
17. Does your company have any ongoing or pending litigation?
If yes, please attach details.

YesNo
18. Financial Information PQF Completed By
Title
Telephone
Fax
VENDOR PRODUCT/FACTORY INFORMATION
19. Factory Location(s)
20. Quality Control Program
21. Union Affiliation/Contract Expiration
22. Factory Contact:
Telephone: Daytime: Night/Emergency
Fax
23. Vendor Product/Factory PQF Completed By
Title
Telephone
Fax
CONTRACTOR SERVICES INFORMATION
24. Major Equipment Owned
25. Type of Services Usually Sub-Contracted
Name
Address
Bonding Capacity

Type of Work

	27. Major jobs completed in the past three years: Customer/Location	$M	Customer Contact	Telephone	Customer /Location

Size

	Type of Work	$M	Customer Contact	Telephone	Customer/Location
1
2
3

Contractor Services PQF Completed By / Title
Telephone
Should be Empty:

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Contractor/Vendor Pre-Qualification Form (PQF)

GENERAL INFORMATION

Business Classification Definitions

FINANCIAL INFORMATION

VENDOR PRODUCT/FACTORY INFORMATION

CONTRACTOR SERVICES INFORMATION