SUBCONTRACTOR PRE-QUALIFICATION FORM

    Company Name *
    Website Address *
    Physical Address *
    Billing Address *

    Officer Name *
    Title *
    Phone (FORMAT: 123-456-7890)
    Email *
    Officer Name
    Title
    Phone (FORMAT: 123-456-7890)
    Email
    Officer Name
    Title
    Phone (FORMAT: 123-456-7890)
    Email

    CA License Number*
    Expiration Date
    Fed Tax ID #

    (Please include copy of pocket license)


    Trades (list all that apply):


    Number of Employees
    Prevailing Wage Work?

    Regions of Work: (please check all that apply)


    Type of Work


    Type of Business


    Years in Business
    Dun & Bradstreet Number:
    Line of Credit Amount $
    Line of Credit Available $

    What was your companies average yearly volume last year?
    Does your company have a written safety program?
    Does your company hold weekly safety meetings?

    Bonding Company
    Agent Name
    Address
    Bonding Capacity

    Has your company ever filed for bankruptcy protection in the U.S. Bankruptcy Court? If yes, please give date filed
    Are there any judgements, claims, arbitration proceedings, or suits pending or outstanding against your company? If so, please explain:

    Dollar range of project you would be interested in

    From
    To

    Project Name
    Project Type
    Project Amt $
    Contractor Name
    Contact Name/Phone
    Project Name
    Project Type
    Project Amt $
    Contractor Name
    Contact Name/Phone
    Project Name
    Project Type
    Project Amt $
    Contractor Name
    Contact Name/Phone

    General Contractor References (required):

    GC Name
    Contact Name
    Contact #
    E-mail
    GC Name
    Contact Name
    Contact #
    E-mail
    GC Name
    Contact Name
    Contact #
    E-mail

    Please attach the following:

    Copy of Contractor’s License

    Copy of Safety Program

    Copy of Insurance Certificates


    THE ABOVE INFORMATION IS ACCURATE TO THE BEST OF MY KNOWLEDGE


    Name & Title
    Date

    Signature