Subcontractor Qualification

COMPANY GENERAL INFORMATION

List the project you wish to quote or list all to be put on master subcontrator list

Company
First Name
Last Name
Street Address
City
State/Province:
Zip/Postal Code
Office Phone
Office Fax
Office Hours
Website

COMPANY DESCRIPTION

Supplier: Labor Only: Supply Install:
Project Types:
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:
Type of Business:
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?:
Does your company bid Davis Bacon Wage projects:
Federal Tax Id #:
Contractor License #:

DIVISIONS OF WORK

Select CSI Divisions of work your perform (select all that apply) :

COMPANY SAFETY RECORD

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?:
If Yes , Number:
If Yes, please explain:
Do you have a qualified person responsible for safety within your Comapny?
Please describe his/her qualifications:
Does this person do safety inspections on all of your Project:
Frequency:
Does your company have a current Written Safety Policy and will you provide copies if requested?:
Does your company have a Drug Free Workplace Program?:
If Yes, please check which are included in the policy:

INSURANCE

Agent Broker:
Contact:
Phone:

FINANCIAL ASSURANCE

Is your company capable of securing a bond if requested?
Bonding Company (not agent):
Aggregate Bonding Capacity:
Single Job Capacity:
Surety Company’s AM Best Rating:
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? :
If involved , please expalin:
Number of Claims/Litigations in past 5 years?:
Any Current Claims:
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?
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?
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?:
If Yes, please explain:

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?:
If Yes, please explain:

AUTHORIZED SIGNATURE

Name:
Title:
Email address for confirmation:
I acknowledge that Atmos Solutions, Inc. will be relying on the accuracy of the above information to assist them in determining whether my organization may be a selected bidder for work with Atmos Solutions, Inc. and authorize my bank, bonding company, and trade suppliers to discuss our business relationship.

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