SECTION #1 – COMPANY & CONTACT INFORMATION
Company Name
*
Company Phone Number
*
Please enter a valid phone number.
Company Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Name
*
First Name
Last Name
Title
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
SECTION #2 – COMPANY BACKGROUND
Trades Performed
*
Self Perform Capabilities
*
Employee Count (Salaried)
*
Employee Count (Hourly)
*
SECTION #3 – SAFETY
Current EMR
*
Fatalities in past 3 years
*
Yes
No
SECTION #4 - PROJECT EXPERIENCE
Average Project Size ($)
*
Maximum Job Size in Last 5 Years ($)
*
Current Backlog
*
Pending Awards
*
Previous Similar Projects
*
SECTION #5 - BONDABLE
Are You Bondable?
*
Yes
No
Single Project Bond Limit
*
Aggregate Bond Limit
*
Bond Rate
*
Date of Last P&P Bond Obtained
*
Surety Company AM Rating
*
Bonding Agent Name and Phone #
*
Previous SDI Experience?
*
Yes
No
SECTION #6 – DIVERSITY
IF YOUR FIRM QUALIFIES AS A CERTIFIED MWVBE OR DBE FIRM, PLEASE FURNISH THE INFORMATION REQUESTED BELOW and attach a copy of your certification:
List all Certifying Agency and Certified Group Classification below:
Rows
Certifying Agency and Certified Group
Classification (i.e. MWVBE OR DBE)
Certificate Number
Expiration
Date
Certificate 1
Certificate 2
Certificate 3
Certificate 4
Certificate 5
Copy of Certifications
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*
I understand that the completion and submittal of this letter is for the sole purpose of allowing Austin Commercial to assemble a list of“interested” entities in the potential construction work associated with the upcoming JPS Hospital Addition. I also understand the completion and submittal of this letter does not constitute a guarantee, or contract for any work associated with the above noted project.
Please verify that you are human
*
SUBMIT
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