General Company Information
Type of Work/Service/Material
*
Type of Company
*
Please Select
Corporation
Partnership
Sole Proprietorship
LLC
Company Legal Name
*
Years of Business (under current name)
*
Street
*
Office Personnel (number of employees)
*
City
*
Country & State
*
Field Supervisors (number of employees)
*
Field Labor (number of employees)
*
Zipcode
*
Federal Tax ID
*
State Tax ID
*
Phone Number
*
Company or Owner Bankruptcy last 5 years?
*
Please Select
Yes
No
Fax Number
*
If yes, please explain
Website
*
Estimating Contact(s) Information
Estimating Contact #1
*
Phone
*
Email
*
Estimating Contact #2
Phone
Email
Project Information
Project Contract Range ($)
*
Annual Volume ($) - Last year
*
Annual Volume ($) - This year
*
Annual Volume ($) - Prior year
*
State(s) where work performed
*
Has company ever defaulted on a project?:
*
Please Select
Yes
No
If yes, please explain
Please provide information on three significant projects in the past three years. Use additional attachments as necessary.
Project Name #1
*
Scope
*
Contract Amount
*
Reference Contact (name, phone and email in one line separated by commas)
*
Project Name #2
*
Scope
*
Contract Amount
*
Reference Contact (name, phone and email in one line separated by commas)
*
Project Name #3
*
Scope
*
Contract Amount
*
Reference Contact (name, phone and email in one line separated by commas)
*
Insurance/Banking Information
Insurance Company
*
Street Address
*
City
*
Country & State/Province/Region
*
ZIP/Postal Code
*
Insurance Agent Name
*
Phone Number
*
Please provide a Certificate of Insurance with current limits
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Bank (Name/Branch)
*
Contact Name
*
Phone Number
*
Legal Information
Are there any judgments, claims, arbitration proceedings, or suits pending/outstanding against your firm or its officer or principals?:
*
Please Select
Yes
No
If yes, please explain
Has your company been involved in any lawsuits, arbitration or mediation with regard to construction contracts within the last five (5) years?:
*
Please Select
Yes
No
Additional Attachments/File Uploads
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Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please ensure to send us a certificate of insurance and a completed w-9 to complete the form. Thank you!
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*
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