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207-377-8699
207-377-8699
Home
About Us
Services
Projects
Collegiate Projects
Healthcare Projects
Municipal Projects
Non-profit Projects
Commercial Projects
Employment
Contact Us
Menu
Home
About Us
Services
Projects
Collegiate Projects
Healthcare Projects
Municipal Projects
Non-profit Projects
Commercial Projects
Employment
Contact Us
Subcontractor Prequalification
"
*
" indicates required fields
BASIC INFORMATION
Company Name
*
Trade(s)
Address
Phone Number
*
Fax Number
E-Mail
*
Primary Contact Person
*
Tax ID/SSN
Type of Company
Sole Proprietorship
Corporation
Partnership
LLC
Date Company Formed
MM slash DD slash YYYY
Total Number of Employees
Names & Titles of Principals of Company
Have you operated under any other name(s) in the past five years?
Yes
No
Provide name(s) & location(s)
RELEVANT EXPERIENCE & PROJECT COMMITMENT
Provide names, dates, contract values and contact info for similar and/or relevant projects that your company has completed. Attach additional pages as necessary
Provide names of key personnel that will be assigned to this project. Indicate volume of other projects these individuals will be responsible for concurrent to this project
FINANCIAL & INSURANCE INFORMATION
Do you have a line of credit from any lending institution?
Yes
No
Lender’s Name, Address, Officer’s name, Phone Number
Do you have the ability to bond projects?
Yes
No
Date of last bonded project
MM slash DD slash YYYY
Single Project Limit
Aggregate Limit
Bonding Company Name & Address
In-Place Volume per year for past five years
Anticipated volume of work to occur simultaneously with this project
State your typical insurance coverages, per occurrence and aggregate (as applicable), for General Liability, Automobile Liability, Umbrella/Excess Liability, and Workers Compensation/Employer’s Liability
SAFETY RECORD
In the past five years, has your company or any of its key personnel been investigated for or found to have committed any OSHA violations?
Yes
No
Provide details
What is your current Workman’s Compensation EMR rate
Please attach copy of current EMR
Max. file size: 768 MB.
Do you have a written employee safety policy & program?
Yes
No
Please attach copy
Max. file size: 768 MB.
Are there any open or aggregate liability claims that would impair your ability to insure a project?
Yes
No
Please attach
Max. file size: 768 MB.
Please explain
OTHER INFORMATION
Has your company or any of its personnel been a party to a bankruptcy or reorganization proceeding?
Yes
No
Provide date
MM slash DD slash YYYY
During the past five years, have any liens been filed against you by any of your subcontractors or suppliers?
Yes
No
Provide details
During the past five years, has your company been involved in any claims, arbitration, mediation, or litigation?
Yes
No
Provide details
Have you ever failed to complete a contract, been defaulted, or had a contract terminated?
Yes
No
Provide date
MM slash DD slash YYYY
Provide details
During the past five years, has your company or any of its principles been involved in any lawsuits arising from construction projects?
Yes
No
Provide details
REFERENCES
Current Projects: (Include name of project, scope of work, contract amount, and completion date)
Name of project
Scope of work
Contract amount
Completion date
Add
Remove
Trade References: (List three of your subcontractors or suppliers; include name, contact, and phone)
Name
Contact
Phone
Add
Remove
Click the small (+) sign on the right to add additional trade references
Client References: (List three clients; include name, contact, and phone)
Name
Contact
Phone
Add
Remove
Click the small (+) sign on the right to add additional client references
The undersigned, on behalf of the Subcontractor, certifies that the information provided herein, including any attachments, is true and sufficiently complete so as not to be misleading.
Name
Signature
Date
MM slash DD slash YYYY
Title
