Subcontractor Prequalification Form

Subcontractor Prequalification Form

Please complete this form and submit with all required attachments.
COMPANY INFORMATION
Name of Company*
Date Formed

MonthDayYear
Date
Address*

Address

Street Address Line 2

CityState

Zipcode
Fax
Format: (000) 000-0000.
Website*
Name(s) of Principal Owners*
Diversity Classification: Please check off any that apply and attach a copy of your certificate below.*

Women Business Enterprise (WBE)Gay, Lesbian, Bisexual and/or Transgender (GLBT)Small Business Enterprise (SBE)Minority Business Enterprise (MBE)Disadvantaged Business Enterprise (DBE)Historically Underutilized Business (HUB)Veteran Owned Business (VOB)None Apply
Please attach a copy of your certificate(s) below.*

Above only applies if you selected a diversity classification above.
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Labor Affiliation:*

UnionOpen Shop
Please list affiliation(s):*
ESTIMATING

List the contact information where bid opportunities should be sent.
Contact Name*
Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Contact Email*
example@example.com
List trades you are interested in bidding:*
Check off the industries you typically work in:*

Corporate / TIEducationalFinancialHealthcareHotelIndustrialPharmaceuticalPublicRetailNon-Profit OrganizationResidential (Singe Family)Residential (Multi-Family/Assisted Living)Restaurant/Fast FoodOther
Check off the types of projects you typically perform:*

Ground Up / New ConstuctionInterior Fit Out (Upfit)RenovationMinor AlterationMaintenance / RepairsSite / LandscapingOther
List the geographical areas in which you work:
List (3) General Contractors that you work with:

Please provide company name and email.
Contractor 1: Name , Email*
Contractor 2: Name , Email*
Contractor 3: Name , Email*
FINANCIAL
Please attach most current financial statement.*

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Please attach a list of the largest contracts your organization has completed in the last (3) years.*

Multiple contracts can be uploaded.
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Dollar Amount Volume for the past 3 years:

Please provide year and dollar amount.
Year 1 = 20 Dollar amount *
Year 2 = 20 Dollar amount *
Year 3 = 20 Dollar amount *
Has your your company or any of it's principals ever filed for bankruptcy?*

YesNo
Please explain the bankruptcy:*
Has your your company failed to complete a contract?*

YesNo
Please explain why:*
Does your company have any open judgments, claims or lawsuits against it?*

YesNo
Please explain:*
Does your company have any open liens against a property?*

YesNo
If yes, please explain:*
SAFETY AND INSURANCE
Does your company have a written safety program?*

YesNo
Has your company been cited by OSHA in the past (3) years?*

YesNo
If yes, please explain:*
Provide your Experience Modification Rate (EMR) for the past 3 years:

Please provide year and rate.
Year 1 = 20 * EMR *
Year 2 = 20 * EMR *
Year 3 = 20 * EMR *
*
Please attach evidence of insurance or statement of coverage limits broken out by category:*

PDF Files Please
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Should be Empty:

Subcontractor Prequalification Form

COMPANY INFORMATION

ESTIMATING

List (3) General Contractors that you work with:

FINANCIAL

Dollar Amount Volume for the past 3 years:

SAFETY AND INSURANCE

Provide your Experience Modification Rate (EMR) for the past 3 years: