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.
Format: (000) 000-0000.
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
Experience Modification Rating (EMR) - Last Three Years
Coverage & Limits
Please upload a sample Certificate of Insurance
*
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Surety & Bonding
Bond Information
*
Bond Agent Information
*
Bond Capacity
*
Upload Bonding Letter
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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.
Finance / Banking
Finance
Please upload your organization’s most recent period end compiled financial statements and most recent balance sheet and income statement may be requested. (Please note: Company financial statements are kept strictly confidential. Access and review of your financial statements will be limited to Loeffler Construction and Consulting’s President and Financial Manager). Summary financial statements prepared by an independent accounting firm may be acceptable in lieu of detailed financial statements. Additional requests for financial information may follow our analysis.
Financial File Upload
*
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Banking
Please upload a bank reference letter indicating current bank balances and lines of credit are adequate to finance the contract size being considered.
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.
Format: (000) 000-0000.
Bank Reference Letter Upload
*
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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
*
Submitted By Email
*
example@example.com
Title
*
Primary Contact
*
First Name
Last Name
Primary Contact Email
*
example@example.com
Project Name Under Consideration
*
Signature
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