1. Contractor Identity
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Company name:
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Area of Expertise:
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Subcontractor
Supplier
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Mailing Address:
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Physical Address (if different than mailing)
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Phone Number:
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Fax Number:
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Email Address:
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Contact Person:
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Date Formed:
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States in which the company is legally qualified to do business:
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Total number of employees:
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Names and titles of key people in company:
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Has the company operated under any other name in the past five years?
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Yes
No
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If yes, list addresses:
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2. MBE/WBE/SBE Certification
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Is the company a certified Minority Business Enterprise (MBE), Women Business Enterprise (WBE), Small Business Enterprise (SBE), or any other type of certified business enterprise?
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Yes
No
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If yes, list:
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3. Bonding Capacity
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Do you have bonding?
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Yes
No
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If yes, give details:
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Single project limit:
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Aggregate limit:
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Bonding company name/address:
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Bonding agent name/address/phone number:
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4. Completed Projects (Summarize representative projects completed in the past five years) Include for each project: Name of Project, Scope of Work, Contract Amount, Completion Date
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5. Current Projects (Summarize current projects) Include for each project: Name of Project, Scope of Work, Contract Amount, Est. Completion Date
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6. Trade References (List three of your subcontractors or suppliers) Include for each: Name of Sub/Supplier, How long have you done business with them?, Contact Info
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7. Client References (List three clients) Include for each: Name of Project, Scope of Work, Contract Amount, Completion Date
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8. Other Information
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Has your company or any of its key people been a party to a bankruptcy or reorganization proceeding?
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Yes
No
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If yes, give date:
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During the past five years, have any liens been filed against you by any of your subcontractors or suppliers?
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Yes
No
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If yes, give details for any liens over $5,000:
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Have you ever failed to complete a contract, been defaulted, or had a contract terminated?
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Yes
No
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If yes, give details:
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In the past five years, have you had liquidated damages assessed against you upon completion or a project?
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Yes
No
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If yes, give details:
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In the past five years, has your company or any of its key people been involved in any lawsuits arising from construction projects?
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Yes
No
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If yes, give details:
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In the past five years, has your company or any of its key people been investigated for or found to have committed a violation of any labor laws?
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Yes
No
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If yes, give details:
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In the past five years, has your company or any of its key people been investigated for or found to have committed any OSHA violations?
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Yes
No
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If yes, give details:
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In the past five years, has your company or any of its key people been investigated for or found to have committed a violation of state, federal, or local environmental protection laws?
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Yes
No
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If yes, give details:
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Is there any other information you would like to give us?
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Please complete the form and submit the following attachments:
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Licenses (copies of your current license or certification, if you are an electrician, plumber, asbestos handler, or in any other trade that requires a license or certification to perform work):
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Certificate of Insurance (general liability, vehicle, & worker's compensation):
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W9:
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