Vendor Qualification Form
General Information
Legal Company Name
Doing Business As (DBA)
Ex: ABC co.
Company Established Year
Ex: 1994
How many years operating under present business name?
Company Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Company Phone Number
Please enter a valid phone number.
Company Contact Email
example@example.com
Website
Company Identification
Has your company operated under any other names?
Yes
No
Previous Company Names & Duration
Federal Tax ID
State Tax ID
State of Incorporation
Type of Ownership
Partnership
Corporation
LLC
Sole Proprietor
Non-Profit
Other
Date of Incorporation
Company Type
Please Select
Architect
Trade Partner
Client
Consultant
Supplier
Is your firm in compliance with EEO requirements?
Yes
No
Company Key Stakeholders
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Resources
% of Work Self-Performed
Labor Type
Please Select
Union
Non-Union
Which Unions?
Does your company use 3rd Party Installers
Yes
No
List subcontractors or Material Suppliers you will use for this project.
Work History
Largest Contract Value
Enter the largest contract amount awarded to your company.
References
Licenses
Upload License Supporting Documents
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Insurance and Bonding
Coverage & Limits
Please upload a sample Certificate of Insurance
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Surety & Bonding
Bond Information
Upload Bonding Letter
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Bond Agent Information
*
Bond Capacity
*
Litigation
Any Current Litigation Claims?
Yes
No
If any open claims, please explain.
Claims in the Last Three Years
Yes
No
If claims in last three years, please explain
Has ever failed to complete a project
Yes
No
If failed to complete a project, please explain.
Has Ever Filed for Bankruptcy
Yes
No
If filed for bankruptcy , please explain.
Has Had Lien Claims
Yes
No
If had a lien claim, please explain.
Bank Reference
Bank Institution
Bank Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Bank Phone Number
Please enter a valid phone number.
Bank Reference Letter
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Additional Information
Schedule: Time is of the essence. Do you represent that you have the quality and quantity of crafts people to maintain the schedule presented by Loeffler Construction & Consulting?
Yes
No
Payment Terms: Progress billing payments to your company will be processed on a "pay if paid and pay when paid basis with retention held. Do you represent that you have adequate financial resources to finance your portion of the project until payment can be processed? (Normally 30-45 days)
Yes
No
Date
-
Month
-
Day
Year
Date
Information Submitted By
Title
Primary Contact
First Name
Last Name
Primary Contact Email
example@example.com
Configurable list
*
Project Name Under Consideration
Signature
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