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Subcontractor Prequalification Form
Subcontractor Prequalification Form
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Contact Us
Subcontractor Prequalification Form
COMPANY INFORMATION
Legal Name of Firm*
(List any DBA’s)
Address*
Type of Company*
Corporation
Partnership
Sole Proprietor
Other
Federal ID*
Scope of Work*
Average Work in Years(last 5 years)
Work under contract:
Average project size in place last year:
Uncompleted backlog:
Current Number of Employees: In Office:
In Field:
List all litigation against your firm in the past 5 years (use separate sheet if necessary):
List all insurance claims over $100,000 in the past 4 years (attach insurance company loss runs):
BONDING, INSURANCE AND SAFETY INFORMATION
Is Subcontractor able to provide bid, payment and performance bonds?
Yes
No
Bonding Company:
A.M. Best Rating
Treasury Listed
Yes
No
Bonding Agency:
Contact Name:
Phone Number:
Insurance Agency Name:
Address:
Contact Name:
Phone Number:
General Liability Limits:
per Occurence
Aggregate
Auto Liability Limits:
Combined Single Limits
WC/Employers Liability:
Umbrella Liability:
per Occurence
Aggregate
Does your firm use any Employee Leasing Companies?
Yes
No
Can your General Liability, Auto and Umbrella policies name General Contractor and Owner as Additional Insured?
Yes
No
Can your GL, WC and Umbrella policies give Waiver of Subrogation to Contractor and Owner?
Yes
No
List WC Experience Modifier for past three policy years:
Does your company have a written safety program and/or policy in place?
Yes
No
Does your company have a written drug policy?
Yes
No
Does your company employ a full-time site safety professional?
Yes
No
LIST FINANCIAL INFORMATION FOR LAST 3 FISCAL YEARS
Year
Annual Sales
Largest Single Contract
COMPLETED PROJECTS: LIST LAST 6 PROJECTS COMPLETED
Name of Project
Contracting Company
Contact Name/Phone
Contract Amount
Completion Date
Bonded
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
COMPLETED PROJECTS: LIST LAST 6 PROJECTS COMPLETED
Name of Project
Contracting Company
Contact Name/Phone
Contract Amount
Completion Date
Bonded
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Completed By:
Title:
Date:
Reset
Submit
