Vendor Prequalification Checklist

Siteline Construction Group, Inc.

Vendor Pre-qualification Checklist
INDEPENDANT SUBCONTRACTOR

Please fill out the form below:
General Liability Insurance

Limits: $1,000,000 Each Occurrence, Products and Completed Operations; $2,000,000 General Aggregate with a per project aggregate limitAdditional Insured: Siteline Construction Group, LLC and [Property Owner TBD] named as Additional Insured on a primary, non-contributory basis
Automobile Liability and Property Damage

Limits: $500,000 Combined Single Limit including hired and non-owned vehicles
Workers Compensation Insurance

Limits: State Statutory Miniumum or Exemption if no employees
Cancellation

Certificates are to provide for a minimum 30 days notice of cancellation or alteration
LICENSURE (Please check all that apply and provide copies with your submittal)

Local Occupational License (Required)State LicenseLocal Competency Certificate
OTHER REQUIRED FORMS (Please provide the following with your submittal)

W-9 or Tax ID Number
I have reviewed this checklist and provided all of the requested information with my prequalification package.
Title & Company Name:*

TitleCompany Name
Vendor/Sub-Contractor Signature:*

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Siteline Construction Group, Inc.