Subcontractor Qualification

Person Completing Form

First Last

Today's Date

Structure of Company

Untitled

Corporation

Sole Proprietor

LLC

Partnership

General or Limited

Joint Venture

Date of Establishment

State Where Established

List of States/ metro areas in which authorized to do work (please include license # if applicable)

VA License:

MD License:

Federal ID #

Other:

Contractor Parent Company

Company Name/ President

Number of Employees (at Contractor Parent Company)

Contractor Parent Address

Contractor Parent Phone

Company Profile

Type of Company

Subcontractor (Furnish & Install)

Subcontractor (Install Only)

Supplier (Materials Only)

CSI Number(s)

SIC Number(s)

Project Size (Check all that apply)

$250,000 or below

$251,000- $499,000

$500,000- $999,999

$1,000,000 or more

Types of Projects

K-12 Schools

Government

Healthcare

Higher Ed

Community

Industrial

Office

Other

Geographic Work Areas: (Check all that apply or list states)

Northern VA

Washington, DC

Maryland

List of States

List States Here

Certified Minority Business Enterprise Contractor (MBE)

Yes

No

Certified By:

Certification Number

Certified Woman Business Enterprise Contractor (WBE)

Yes

No

Certified By:

Certification Number

Do you have experience with LEED/green buildings?

Yes

No

Bonding & Insurance

Name of Bonding Agency

Name

Relationship Officer:

Phone

Fax

Bonding Company

A.M. Best Rating on Bonding Company:

Bonding Capacity Single Job:

Bonding Capacity Aggergate:

Please attach workers comp and general liability insurance certificates.

Max. file size: 300 MB.

What is your workers comp EMR (experience modification rate) for the last 3 years?

Year, EMR

Please attach copy of previous year’s OSHA 300 form.

Max. file size: 300 MB.

Work in Progress

Amount of work under contract ($):

Amount of that work not yet completed ($):

Please provide the following attatchments:

Provide a list of projects in your current backlog.

Max. file size: 300 MB.

Provide Surety Letter from bonding company.

Max. file size: 300 MB.

Provide most current audited financial statement.

Max. file size: 300 MB.

Trade References

Please list three trade/vendor references with whom you have worked for in the last year.

Trade Reference 1:

Name

Contact

First Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Contact Phone Number/ Cell Number:

Trade Reference 2:

Name

Contact

First Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Contact Phone Number/ Cell Number

Trade Reference 3:

Name

Contact

First Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Contact Phone Number/ Cell Number

General Contracting References

Please list three general contractors with whom you have worked for in the last year.

General Contractor Reference 1:

Name

Contact

First Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Contact Phone Number/ Cell Number

General Contractor Reference 2:

Name

Contact

First Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Contact Phone Number/ Cell Number

General Contractor Reference 3:

Name

Contact

First Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Contact Phone Number/ Cell Number

Credit Authorization

The submitter of this prequalification form authorizes contacting any of the references given on this form and further authorizes each of those representatives to disclose any and all information the reference may have regarding the submitter. Also, the submitter authorizes the release of credit information including a credit report or other sources of credit information and this authorization shall be without expiration. Do you agree to these terms?

Yes

No

Dunn & Bradstreet #

Signature of Officer:

Date

Title:

Fax Number:

Return Completed Form ATTN:

Company:

Please complete requested information on company’s recent major construction projects either completed or in progress; or attach list. (Please make additional copies as needed).

Attach list here (if needed)

Max. file size: 300 MB.

Name of Project

Client/ Owner

General Contractor

Location

Contract Value

Description of Work Being Preformed

Architect/ Engineer

General Contractor Contact

First Last

Phone

Completion (Planned) Date

Name of Project

Client/ Owner

General Contractor

Location

Contract Value

Description of Work Being Preformed

Architect/ Engineer

General Contractor Contact

First Last

Phone

Completion (Planned) Date

Name of Project

Client/ Owner

General Contractor

Location

Contract Value

Description of Work Being Preformed

Architect/ Engineer

General Contractor Contact

First Last

Phone

Completion (Planned) Date

Name of Project

Client/ Owner

General Contractor

Location

Contract Value

Description of Work Being Preformed

Architect/ Engineer

General Contractor Contact

First Last

Phone

Completion (Planned) Date

Do you currently have any outstanding claims?

Yes

No

If yes, please explain. You may attach additional documentation.

Subcontractor Pre-Qualification Form

Company Information

Structure of Company

Company Profile

Bonding & Insurance

Please provide the following attatchments:

Trade References

General Contracting References

Credit Authorization