Warren County Consolidated Elementary School

Warren County Consolidated Elementary School

Prequalification to Bid
This form is for prequalification to bid only (everyone must submit this form).

All interested firms must submit a prequalification form to be eligible to bid on this projects. Please note that packages exceeding 250K require completion of the formal LeChase Prequalification via Trade Tapp. Only firms prequalified through this process will receive notifications for bidding on larger packages. Ensure timely submission of the prequalification form to avoid any delays in the bidding process.
Company Name
Name

First NameLast Name
Title
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Scope of Service
Additional Scope of Service
Date Business Incorporated
Organization Type
Size of Labor Force
Work mix- select all that apply
Are there any judgments, claims, arbitration proceedings or suits pending or outstanding against your organization or its officers.
Has your firm been involved with bankruptcy or reorganization proceedings
Have any of the company owners, officers or executives ever been indicted or convicted of any felony or other serious criminal conduct.
Has your firm been barred from bidding public work
Has your firm filed a claim in the past 5 years.
Single project bidding dollar limits for your company
Present work backlog-list five(5) largest projects and dollar value within last 5yrs.
Project References- list three(3) references on recent projects to include contact information.
Ability to Bond Project if applicable
Safety Manuals: select all that apply
Upload Safety Manuals selected above

Cancelof
Workers Compensation Experience Modification Rate (EMR) last 2 years
Total Recordable Incident Rate (TRIR) last 2 years
Number of OSHA Recordable Injuries and Illnesses last 2 years
List and describe any OSHA violations as defined at www.osha.gov
LEED Experience
Small Business?
Does your firm have NC State Construction experience?
Attached current certificate of insurance

Cancelof
Attach current W-9

Cancelof
The undersigned certifies that the information provided herein is true andently complete so as not to be misleading.
Printed Name
Should be Empty: