Subcontractor Prequalification Questionnaire
Please complete this form and submit all required documents.
Section 1: Organization Information
Please provide your Federal Tax I.D.
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COMPANY HEADQUARTERS INFORMATION:
Company Name
*
Also Known As
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Organization
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Corporation
Partnership
Joint Venture
LLC
Type of work performed
*
Government
Hospitality
Commercial
Healthcare
Education
Retail
Other
Company Contact
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Fax
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Bid Contact
*
First Name
Last Name
Bid Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Bid Contact Email
*
example@example.com
Accounts Payable Contact
*
First Name
Last Name
Accounts Payable Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Accounts Payable Email
*
example@example.com
Accounts Receivable
*
First Name
Last Name
Accounts Receivable Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Accounts Receivable Email
*
example@example.com
Website
Indicate in which State(s) your company conducts work
*
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Section 2: General Information
License Information (enter your company's contractor license information)
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Rows
State
Class
License Number
Expiration Date
1
2
3
4
Minority Business Enterprise Status
HUBZone Small Business
Small Disadvantaged Business
Veteran-owned Small Business
Women-owned Business Enterprise
Minority-owned Small Business Enterprise
Service Disabled Veteran-owned Small Business
Women-owned Small Business
Small Businss
Other
Is your firm signatory to any Unions?
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Yes
No
Union Affiliations (include union name and local)
*
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Section 3: Insurance Information
Please review The Berg Group's requirements. A Blanket Certificate of Insurance (COI) will cover all projects with (per contract terms) with The Berg Group.
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We have reviewed the attached Berg Group insurance documents and we meet the requirements?
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Yes
No
If you checked NO, from the list below, please note which insurance requirement(s) you do NOT meet:
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GL Limits per occurrence are only $1M with no Umbrella/Excess Policy
Aggregate limits do not apply separately per project
Additional Insured Endorseement does not cover completed operations
Mold coverage in GL Policy or Separate Pollution Liability Coverage
Additional Insured Endorsement does not include primary working
Other
Insurance Comments
Are you in a municipal state (ND, OH, WA or WY)?
*
Yes
No
If yes, please upload your Work Comp coverage from your state.
*
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Insurance Broker Name
*
General Liability Policy Number
*
General Liability Policy Expiration Date
*
-
Month
-
Day
Year
Workers Compensation Policy Number
*
Workers Compensation Policy Expiration Date
*
-
Month
-
Day
Year
Date
Please upload your COI
*
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Section 4: Safety Information
(Osha Form 300A must be Attached)
Does your company have a written field-based safety program?
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Yes
No
Is your company part of an OSHA partnership?
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Yes
No
Does your company use project-specific safety plans?
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Yes
No
Does your company have a substance abuse policy?
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Yes
No
Do you hold site safety meetings?
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Yes
No
Does your company have a written safety manual?
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Yes
No
Do you conduct project-site safety inspections?
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Yes
No
Does your company have yearly safety trainings? (fall protection, MEWPS, silica, hazard communication)
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Yes
No
Does your company have a full-time safety director/inspector/manager?
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Yes
No
If yes, please provide contact information (name, phone number, email)
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Please enter the following Safety metrics
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Rows
Citations
EMR
# of Recordable Injuries
RIR
2025
2024
2023
Pleas upload your OSHA 300A logs for the past 3 years
*
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If you had an OSHA citation in the last 3 years, please provide an explanation.
Please attach your OSHA citation, what it was for and your corrective action.
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Please upload your Safety Manual and/or EHS Manual
*
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Please upload your Safety Training Documents
*
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Section 5: Surety Information
Is your company bondable
*
Yes
No
Surety Company
*
Broker Name
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Single Project Bonding Capacity
*
Aggregate Project Bonding Capacity
*
Current Amount Under Bond Today
*
Please upload a letter from your surety company
*
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Section 6: Financial Information
Financial Year Ending
*
Do you have a D&B Number?
*
Yes
No
If Yes, Number
*
Year Company Founded
*
Fiscal Year End Date
*
Subsidiary Name(s)
Parent Organization
Has your company ever filed for bankruptcy?
*
Yes
No
If Yes, Year?
If Yes, Explain
Accounting Firm
*
Accountant
*
Provide your company contact who can discuss financials:
*
First Name
Last Name
Title/Position
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
Please upload your most recent audited financials.
*
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Bank Reference(s)
Bank
*
Contact Name
*
First Name
Last Name
No. of Years Account Held
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Bank
Contact Name
First Name
Last Name
No. of Years Account Held
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Please upload your bank reference letter
*
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Section 7: Litigation Information
Any current litigation with Owners or Contractors?
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Yes
No
If Yes, enter brief description:
Any judgments against your company in the last 5 years?
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Yes
No
If Yes, enter brief description:
Any principals of your company in litigation?
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Yes
No
If Yes, enter brief description:
Any paid liquidated damages?
*
Yes
No
If Yes, enter brief description:
Any labor law violations?
*
Yes
No
If Yes, enter brief description:
Have you ever defaulted on a contract?
*
Yes
No
If Yes, enter brief description:
Have you ever failed to complete a contract?
*
Yes
No
If Yes, enter brief description:
Have you ever been terminated from a contract?
*
Yes
No
If Yes, enter brief description:
Have you ever had your license revoked or suspended?
*
Yes
No
If Yes, enter brief description:
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Section 8: Relevant Experience
List projects in the past 3 year that your company has performed the subcontract work. You are hereby giving permission for us to contact the parties involved in the relevant experience list.
Project 1
*
Project 2
*
Project 3
*
Project 4
*
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Section 9: References Information
Company Name
*
Contact Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Name
*
Contact Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Name
*
Contact Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Name
*
Contact Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Section 10: Signature
The undersigned, on behalf of your company, certifies under oath that the information provided herein, including any attachment, is true and sufficiently complete.
Signed By:
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First Name
Last Name
Title
*
Date
*
-
Month
-
Day
Year
Date
Signature
*
Submit
Should be Empty: