Subcontractors - Suppliers Prequalification Form
Section 1: Basic Information
Date:
Company Name:
Physical Address:
Mailing Address:
City:
State:
Zip:
Phone:
Fax:
Contact:
Cell:
E-Mail:
List the regions you work in
List States that your company holds licenses in.
State:
License:
State:
License:
State:
License:
Union/Non-Union
Non-Union Only
Union Only
Union and Non-Union
Trade/Division
1:
2:
3:
List GC's you are currently performing work for:
1:
2:
3:
4:
Section 2: Experience
1: List 4 Trade References:
Company
Contact
Phone
1:
2:
3:
4:
2: List 3 Projects presently under construction:
A:
Project:
Owner:
Start Date:
Finish Date:
Contract Amount:
B:
Project:
Owner:
Start Date:
Finish Date:
Contract Amount:
C:
Project:
Owner:
Start Date:
Finish Date:
Contract Amount:
Section 3: Financial
1: List Company's volume for past Three years.
Private Work
Public Work
2: Current Back Log of Work through the next 12 months:
3: Have you ever failed to complete a project?:
Yes
No
4: Are you signatory to any labor agreement?:
Yes
No
5: Do you offer health insurance for your employees:
Number of Employees:
Yes
No
6: What are your Standard Limits of Insurance Coverage?
Insurance Co.
Phone Number
Limit
General Liability
Umbrella
Design / Build
Workers Comp.
7: Is your company bondable?
Yes
No
8: Workers Compensation Modification Rating for the past three years (EMR)
EMR
9: Do you qualify as a SOMWBA approved Minority Business Enterprise (MBE)?
Yes
No
10: Do you qualify as a SOMWBA approved Women Owned Enterprise (WBE)?
Yes
No
11: Do you qualify as a Small Business Enterprise?
Yes
No
Section 4: OSHA
1: Do you have a written Safety Program?
Yes
No
2: Do you require your field employees to be OSHA 10 Hour Certified?
Yes
No
3: Have you been cited by OSHA within the last 5 years?
Yes
No
Section 5: Other
1: Is your company a member of any Trade / Business Association?
Please List
2: Minimum Size of Job your Company would like to
3: Maximum Size of Job your Company would like to