Subcontractor Qualification Form

Information must be completed to be considered for pre-qualification.

Submitted By

Contact Person

EMR Rating For the Last Three Years

Type of Business

CorporationIndividualPartnershipJoin VentureOther

Type of Work

General ConstructionHVACPlumbingElectricalOther

Is Your Business A:

Union
YesNo

Certified Small Business
YesNo

Certified Minority Business Enterprise (MBE)
YesNo

Certified Women Business Enterprise (WBE)
YesNo

Certified Veteran's Business Enterprise (VBE)
YesNo

A. Organization

Corporation Information

Partnership Information

Individually Owned Information

Please describe your business and its principals.

B. Licensing

1. List jurisdiction and trade categories in which your organization is legally qualified to do business, and indicate registration or license numbers, if applicable.

2. List jurisdiction in which your organization's partnership or trade name is filed.

C. Experience

1. List the categories of work that your organization normally performs with its own forces.

2. Claims and Suits (if the answer to any of the questions below is yes, please attach details)

A. Has your organization ever failed to complete any work awarded to it?
YesNo

B. Are there any judgments, claims, arbitration proceedings or suits pending or outstanding against your organization or its officers?
YesNo

C. Has your organization filed any lawsuits or requested arbitration with regard to construction contracts within the last five years?
YesNo

3. Within the last five years, has any officer or principal of your organization ever been an officer or principal of another organization when it failed to complete a construction contract? (If the answer is yes, please attach details).
YesNo

4. List major construction projects your organization has in progress, giving the name of the project, owner, architect, contract amount, percent complete and scheduled completion.

5. State total worth of work in progress and under contract.

6. List the major projects your organization has completed in the past five years, giving the name of the project, owner, architect, contract amount, date of completion and percentage of the cost of the work performed with your own forces.

7. State average annual amount of construction work performed during the past five years.

8. List the construction experience and present commitments of the key individuals of your organization.

D. References

1. Vendor/Supplier References (Please list supplier name, address, phone and email. Three (3) Trade References required.):

2. Bank References:

3. Surety:

4. Name of Bonding Company:

5. Country of Bonding Company:

6. Name and address of agent:

7. Financing:

E. Financial Statement

1. Attach a financial statement, preferably audited, including your organization's latest balance sheet and income statement showing the following items:

A. Current Assets (e.g., cash, joint venture accounts, accounts receivable, notes receivable, accrued income, deposits, materials inventory and prepaid expenses)
B. Net Fixed Assets
C. Other Assets
D. Current Liabilities (e.g., accounts payable, notes payable, accrued expenses, provision for income taxes, advances, accrued salaries and accrued payroll taxes)
E. Other Liabilities (e.g., capital, capital stock, authorized and outstanding shares par values, earned surplus and retained earnings)
F. Name and address of firm preparing attached financial statement, and date thereof

2. Is the attached financial statement for the identical organization named on page one?
YesNo

A. If not, explain the relationship and financial responsibility of the organization whose financial statement is provided (e.g., parent-subsidiary).

B. Will the organization whose financial statement is attached act as guarantor of the contract for construction?
YesNo

I certify that the information herein is true and sufficiently complete as not to be misleading.