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Subcontractor Prequalification

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    Company

    Company Information

    Business Name:

    Website:

    Phone:

    Email:

    Address:

    Organized As:
    Organized/Registered in State:
    Specialities:

    Other Information:

    Upload most recent W-9 with appropriate entity name and signed within the past year

    General Contractor References

    Company Name:

    Contact:

    Phone:

    Email:

    Company Name:

    Contact:

    Phone:

    Email:

    Company Name:

    Contact:

    Phone:

    Email:

    Company Name:

    Contact:

    Phone:

    Email:

    Certificate of Insurance

    Please submit a certificate of insurance outlining your current insurance policies. The certificate should outline the policy types, limits, carriers, and any applicable deductible or Self Insured Retention (SIR) associated with each policy. This is not meant to meet any project specific insurance requirements that will be requested and required at a later date.

    Other Information

    Is your firm operating under any other name:
    Has your company or any of its principals been accused or convicted of a crime involving fraud, deceit or corruption in connection with any project?:
    Has your firm or any of its principals ever petitioned for bankruptcy?:
    Are there any judgements, claims, arbitration proceedings, or suits pending/outstanding against any principals?:
    Has your firm filed any lawsuits or requested arbitration or mediation with regard to construction contracts within the last three years?:
    Has any contractor's license held by your company ever been suspended or denied or revoked?:
    Has your company ever been debarred or precluded from public works?:
    Has your firm or any other organization with which your owners, officers or principals were involved during the past 5 years, ever failed to complete any work awarded or been terminated for cause?:

    Safety Information

    Have you incurred any work-related fatalities within the past three (3) years?:
    Has your company received an OSHA citation within the past three (3) years?:
    Has your company received any environmental citations or notice of violation within the last three years?:

    Affidavit

    By clicking on "Agree" below I acknowledging that our company and the owner will be relying upon the accuracy of the information provided on the Prequalification Statement submitted through the Prequalification Website to assist them in determining their discretion on whether any organization can be selected bidder for individual work categories or combined work categories as established in the bid documents.

    By clicking on "I Agee" below, I am further certifying that I am an Owner, Officer, or other induvial authorized to submit this information and bind my company to the representations herein.

    I understand the questions on the Prequalification statement and have answered truthfully and to the best of my knowledge.