Prequalification

Home » Prequalification

1General Information

2Additional Information

3Headcount

4Technology

5Safety

6Safety Metrics

7Quality

8Projects

9Insurance

10Liability

11Financial

12CPA

13Bonding

14Ownership

15States

16Unions

17Legal

18Documents

19Preview

General Information

Company Name

Phone

Fax

Payment Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Additional Info for payment address

Additional Address

Purchase Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Website

Additional Information

Organization Established

MM slash DD slash YYYY

Organization Type

Incorporation Country

Incorporation State

Date of Registration

MM slash DD slash YYYY

Federal Tax ID

Office Type

Parent Organization

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Additional Address Information for Parent Organization

Other names/DBAs used over the last 5 years

Trade Associations

Number of Employees

Executive Management

Present

3-Year Average

Office Management/Staff

Present

3-Year Average

Shop/Equipment Management/Staff

Present

3-Year Average

Job Site Management/Staff

Present

3-Year Average

Trades People

Present

3-Year Average

Union

Shop Type

Accounting/Job Cost System

Software Name

First Installed

MM slash DD slash YYYY

Current Version

Operating System

Database

Project Management System

Software Name

First Installed

MM slash DD slash YYYY

Current Version

Operating System

Database

Highest Ranking Safety Executive

Name

First Last

Title

Phone

Fax

Certifications

Documented Safety Meetings

Documented Safety Meetings - New Hires

For New Hires

Frequency

Documented Safety Meetings - Field Supervisors

For Field Supervisors

Frequency

Documented Safety Meetings - Employees

For Employees

Frequency

Documented Safety Meetings - Subs/Vendors

For Subs/Vendors

Frequency

Company Safety Programs/Policies

A safety officer conducts safety inspections on all projects

Have implemented 100% fall protection

Can provide a site-specific program addressing fall hazards in your work

New employee safety training

Employee safety recognition program

Disciplinary program for safety violations

Accident/incident investigations

Workplace sexual harassment training

Affirmative action plan for employees

Review the safety management system of subcontrators

Require employees to be subject to project-specific substance abuse screening

Written safety program/policy

Written disciplinary policy

Annual safety goals

Return to work/light duty program

Substance Abuse Screening

Pre-Employment

Random

Periodic

Post Accident

Reasonable Suspicion

Safety Metrics

Please provide the three most recent completed years.

Use the (+) button on the right to add years.

Year

Total Hours

Lost Day Cases

Lost Days Rate

Total Recordable Rate

Fatalities

EMR

Vehicle Accidents

Vehicle Accident Cost

Total Liability Loss

OSHA Violations

Willful Violations

Highest Ranking Quality Executive

First Last

Title

Phone

Fax

Certifications

Company Quality Programs/Policies

Written quality policy

Implemented a quality system

Has LEED AP employees

Company has experience with LEED projects

# of LEED Professionals

# of LEED Projects

Largest Project Ever

Project Name

Customer

Value of Work

Year

Your Scope of Work

Largest Project This Year

Project Name

Customer

Value of Work

Year

Your Scope of Work

Largest Project Last Year

Project Name

Customer

Value of Work

Year

Your Scope of Work

Preferred Project Size

Indicate preferred project size (1-5), 1 being most preferred.

List

< $50K

$50K - $100K

$100K - $200K

$200K - $500K

$500K - $1M

$1M - $3M

$3M - $6M

$6M - $10M

$10M - $15M

$15M - $25M

$25M - $50M

$50M+

Insurance Agency

Agent/Broker

Agent Name

Phone

Fax

Contact

Years with Agent

Please enter a number greater than or equal to 0.

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Additional Address

Workers Comp and Employers Liability

Carrier

Policy Form

Policy Number

Policy Period - From

MM slash DD slash YYYY

Each Accident

Current

Maximum

Limit

Professional Liability Insurance

Carrier

Policy Form

Policy Number

Policy Period - From

MM slash DD slash YYYY

Deductible

Tail Years

Project Limit

Prior Acts Coverage

Yes

Commercial General Liability

Carrier

Policy Form

Policy Number

Policy Period - From

MM slash DD slash YYYY

Number of Claims Made in the Last 3 Years

Exclusions to standard CGL

General Aggregate

Current

Maximum

Each Occurrence

Current

Maximum

Deductible

Excess Liability

Carrier

Policy Form

Policy Number

Policy Period - From

MM slash DD slash YYYY

Type

Number of Claims Made

Aggregate

Current

Max Obtainable

Each Occurrence

Current

Max Obtainable

Automobile Liability

Carrier

Policy Form

Policy Number

Policy Period - From

MM slash DD slash YYYY

Combined Limit

Current

Max Obtainable

D & B Information

D & B Number

D & B Rating

D & B Pay Record

Date of Rating

MM slash DD slash YYYY

Financial Information

Revenue Year

Revenue Amount

Working Capital

Average Employees

Expected Volume

Expected Number of Projects

Please enter a number greater than or equal to 0.

Current Backlog

Liquidated Damages

Have been assessed liquidated damages for late completion of a project (see notes for details)

Notes

Bank Information

Bank Name

Branch

Contact

Phone

Years With Bank

Please enter a number greater than or equal to 0.

Line of Credit Total

Line of Credit Available

Line of Credit Expiration

MM slash DD slash YYYY

Bank Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Additional Address

Firm Name

Contact

Phone

Fax

Years with CPA

Please enter a number greater than or equal to 0.

Financial Statements

Surety Company Information

Surety Name

Surety Broker Name

Contact

Phone

Fax

Years with Surety

Please enter a number greater than or equal to 0.

Bonding Capacity

Capacity Per Job

Last Bond Date

MM slash DD slash YYYY

Last Bond Amount

Last Bond Rate

Surety Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Additional Address

Additional Bond Information

Surety had to finish project(s) - See notes for dates/details

Explanatory Note

Indemnity agreement requires personal guarantee

Ownership

Seq

Name

Role

Birth Year

Ownership %

States

Country

State

License

Expiration

Sales Tax #

Unemployment ID #

Unions

Seq

Local Number

Name

Expiration

Legal Questions

Legal Questions - Bankruptcy/Terminated

Has your company or any of its principals ever petitioned for bankruptcy, failed in business, defaulted, or been terminated on a contract awarded? If yes, check here and enter explanatory notes.

Explanatory Notes

Legal Questions - Criminal Conduct

Have any of the owners, officers, or major stockholders of your company ever been indicted or conviced of any felony or other criminal conduct? If yes, check here and enter explanatory notes.

Explanatory Notes

Legal Questions - Precluded

Has your company or any of the owners, officers, or major stockholders ever been suspended, disbarred, or otherwise precluded from persuing public work or ever been found to be non-responsive to a public agency? If yes, check here and enter explanatory notes.

Explanatory Notes

Legal Questions - Warranty

Has your company ever had a claim made against it for improper, delayed, defective, or non-compliant work or failure to meet warranty obligations? If yes, check here and enter explanatory notes.

Explanatory Notes

Legal Questions - Arbitration/Litigation

Is your company or any of the owners, officers, or major stockholders involved in any arbitration or litigation? If yes, check here and enter explanatory notes.

Explanatory Notes

Legal Questions - Judgements/Claims

Does your company have any outstanding judgements or claims against it? If yes, check here and enter explanatory notes.

Explanatory Notes

Legal Questions - Employment

Has your company or any of the owners, officers, or major shareholders ever been investigated for, or charged with, alleged labor laws violations of Immigration Control and Reform Act; state or local laws regarding employment of immigrants; prevailing wage and hour laws or other federal, local, or state labor laws? If yes, check here and enter explanatory notes.

Explanatory Notes

Please upload the following documents.

Drop files here or

Accepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 128 MB.

Certificate of Insurance

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Accepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 128 MB.

EMR Rating

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Accepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 128 MB.

OSHA 300A Summary Logs

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Accepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 128 MB.

Company Safety Manual

Drop files here or

Accepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 128 MB.

Preview

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