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Master Independent Contractor Agreement

Master Independent Contractor Agreement

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Published by micazus

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Published by: micazus on Jul 10, 2011
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07/12/2011

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Pre Qualification
Request for Subcontractors
Merchant Industrial Contracting is looking forSubcontractors to work on opportunities in Arizona.Please complete application and fax to 623 738-0480 or by mail to MIC, 20600 W. Beloat Rd.,Buckeye AZ 85326. If you have questionsconcerning the Application; Contact Brian Shockeyat 623-521-5071, BShockey@micaz.us
 
CONTRACTOR PRE-QUALIFICATION FORM
Date:________________________________________________________________________________Name of Firm:_____________________________________ Website Address:______________________ _________________________Address:_____________________________________________________City:______________________ State:___________________ Zip:________________________________Telephone:________________ Fax:_____________________ Email:______________________________Contact Person:_____________________________ Title:______________________________________Phone:___________________________Email:_______________________________________________How long has your firm been in Business?___________________________________________________
Number of personnel in organization:
Administrative____________Professional_____________Office_________Shop_______Field_______Type of work performed and specific trade(s) Offered: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
Construction License Numbers associated with trades:_______________________________________
 ____________________________________________________________________________________Is your firm a union shop?______________ If yes your local #_____________________Has your firm ever been bonded? Yes___ No_______If yes; what Bonding company:___________________________Phone:___________________________Address:______________________________________________________________________________Agent:________________________________________________________________________________Bonding Capacity: Single________________ Aggregate________________________________________Can your firm provide a bid bond, performance bond and a payment bond? Yes_________No_________Comments:
 
Bank References:Name of Bank Address Contact/Phone
Insurance Company Information:
(General Liability, Auto and Workman’s Comp)
 
Name of Company:_____________________________________________________________________Address:______________________________________________________________________________Contact Name:_________________________________ Phone#:_________________________________Name of Company:_____________________________________________________________________Address:______________________________________________________________________________Contact Name:_________________________________ Phone#:_________________________________Name of Company:_____________________________________________________________________Address:______________________________________________________________________________Contact Name:_________________________________ Phone#:_________________________________Annual Contract Volume (last 3 years) (200_)_____(200_)_______(200_)_____
List a minimum of 5 trade/project references in the last five years:
Client/Project Contact Name Phone # Type of Work Dollar Value
List a minimum of 3 Supplier references:
Client/Project Contact Name Phone # Type of Work Dollar ValueAre there any judgments, claims or suits pending or outstanding against you? Yes____ No____Have you ever failed to complete a project? Yes____ No____Are you currently barred from bidding on public work? Yes____ No___(If you answered Yes to any of the questions listed above; Provide details on a separate sheet of paper)

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