Subcontractor Qualification Forminator

COMPANY GENERAL INFORMATION

List the project you wish to quote or list ALL to be put on master subcontractor list *

Company *

Street Address *

City *

State/Province *

ZIP / Postal Code *

Office Phone *

Office Fax *

Office Hours *

Website

Company Description

SupplierLabor OnlySupply & Install

If Other

COMPANY STRUCTURE

Corporate Officers

Corporate Officer 1 *

Position/Title *

Cell Phone *

Ownership % *

Email Address *

Corporate Officer 2

Position/Title

Cell Phone

Ownership %

Email Address

Financial Contacts

Financial Contact *

Position/Title *

Phone Number *

Cell Phone *

Email Address *

Bid Contacts

Bid Contact 1 *

Position/Title *

Phone Number *

Cell Phone *

Email Address *

Bid Contact 2

Position/Title

Phone Number

Cell Phone

Email Address

Union - Local # *

Years In Business *

Number of FULL TIME Associates *

Number of PART TIME Associates *

Number of OFFICE Associates *

Number of FIELD Associates *

Does your company bid Prevailing Wage projects? *YesNo

Does your company bid Davis Bacon Wage projects? *YesNo

Federal Tax ID# *

Contractor License # *

Please attach a current W-2 Form *

No file chosen

DIVISIONS OF WORK

COMPANY SAFETY RECORD

Please attach your OSHA No. 300 log(s) for the past 3 years

(accepted file types: jpg, jpeg, gif, pdf)

Experience Modification Ratings (EMR) Current Year (2021)

Experience Modification Ratings (EMR) Last Year (2020)

Number of work-related injuries and illnesses (2021)

Prior Year (2020)

Second Prior Year (2019)

Has your company had any OSHA fines or jobsite fatalities in the past 3 years?YesNo

If yes, number

If yes, please explain

Do you have a qualified person responsible for safety within your Company?YesNo

Please describe his/her qualifications

Does this person do safety inspections on all of your projects?YesNo

Frequency

Does your company have a current Written Safety Policy and will you provide copies if requested?YesNo

Does your company have a Drug Free Workplace Program?YesNo

If Yes, please check which are included in the policy:Pre-Hire/Initial EmploymentCausePost-Accident/IncidentRandom Periodic

INSURANCE

Agent Broker *

Contact *

Phone *

Please attach a current certificate of insurance *

No file chosen

FINANCIAL ASSURANCE

Is your company capable of securing a bond if requested? *YesNo

Bonding Company (not agent) *

Aggregate Bonding Capacity *

Single Job Capacity *

Surety Company’s AM Best Rating

Please attach a completed Surety Letter *

No file chosen

(accepted file types: jpg, jpeg, gif, pdf)

Dunn & Bradstreet # *

DUNS Rating *

Name of Bank *

Credit Line *

Is your Company or any of its Owners, officers or major stakeholders currently involved in any arbitration or litigation? *YesNo

If Yes, please explain

Number of Claims/Litigations in past 5 years? *

Any Current Claims *YesNo

Has your Company or any of its principals ever petitioned for bankruptcy, failed in business, defaulted or been terminated on a contract awarded to you? *YesNo

If Yes, please explain

Have any of the Owners, officers or major stockholders or your Company ever been indicted or convicted of any felony or other criminal conduct? *YesNo

If Yes, please explain

Has your Company or any Owners, officers or major stockholders ever been suspended, disbarred or otherwise precluded from pursuing public work or ever been found to be non-responsive by a public agency? *YesNo

If Yes, please explain

Please attach a current financial statement, preferably audited, including your latest balance sheet and income statement *

No file chosen

(accepted file types: jpg, jpeg, gif, pdf)

TRADE REFERENCES

Company

Contact

Phone

Company

Contact

Phone

Company

Contact

Phone

CURRENT/RECENT PROJECTS

Enter the values for Volumes and Years as a Number with no special characters or spaces (i.e. One Million = 1000000).

What is your expected annual volume this year

Number of projects

What was the average annual volume of work performed over the past 5 years:

Year

Volume

Year

Volume

Year

Volume

Year

Volume

Year

Volume

List your 5 largest projects in the last 3 years

Project Name

Project Location

Contract Value

% Complete

Project Name

Project Location

Contract Value

% Complete

Project Name

Project Location

Contract Value

% Complete

Project Name

Project Location

Contract Value

% Complete

Project Name

Project Location

Contract Value

% Complete

Have you ever failed to complete a construction contract?YesNo

If Yes, please explain

AUTHORIZED SIGNATURE

Name

Title

Please provide your email address for confirmation of your form submission.

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Contacts

COMPANY GENERAL INFORMATION

Company Description

COMPANY STRUCTURE

Corporate Officers

Financial Contacts

Bid Contacts

DIVISIONS OF WORK

COMPANY SAFETY RECORD

INSURANCE

FINANCIAL ASSURANCE

TRADE REFERENCES

CURRENT/RECENT PROJECTS

Enter the values for Volumes and Years as a Number with no special characters or spaces (i.e. One Million = 1000000).

What was the average annual volume of work performed over the past 5 years:

List your 5 largest projects in the last 3 years

AUTHORIZED SIGNATURE

Contact Information

Our Offices

Our Services

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