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Subcontractor Pre-Qualification Statement

Subcontractor Pre-Qualification Statement

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Published by Warren Reidhead

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Published by: Warren Reidhead on Jun 21, 2012
Copyright:Attribution Non-commercial

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06/01/2013

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*NOTE:Applicationsmustbecompletedwithinsixty(60)daysortheywillnotbereviewed.
SubcontractorPre-qualification
DateSubmittedCompanyFederallDNumberAddressYearBusinessStartedCityEstimatorE-mailState
D
IPCode
1'--_'
Phone
1-1--'
FaxWebSiteAZDustControlNo.Attachalistofanyadditionallicenses
o
NoDSubcontractorDVendor/SupplierDPartnershipDLimitedLiabilityCompanyListthename,title,yearswiththecompanyandpercentofownershipofthecompany'sprincipalsDSoleProprietorYearswithCompanyPercentOwnershipNameTitle
DDD
Isyourcompanyownedorcontrolledbyaparentcompanyoranyotherorganization?
0
Yes
o
NoBriefexplanationDDBEDVBEDSBEDNativeAmericanheckapplicablecertification(s)DMBEDWBEDNavajoProvidenumberofOfficePersonnelAverageShop
I
Labor
L..-__
...J
Field
I.I
AverageFieldSupervisorsLabor
'-------'
 
SubcontractorPre-qualification
page
2
Arethereanyjudgements,claims,arbitrationproceedingsorsuitspending/outstandingagainstyourfirmoritsofficersorprincipals?
o
Yes
o
NoIfyes,attachacompleteexplanation.Hasyourcompanyfiledanylawsuitsorrequestedarbitrationormediationwithregardtoconstructioncontractswithinthelastfive(5)years?
o
Yes
o
NoIfyes,attachacompleteexplanation.Hasyourcompanyoranyotherorganizationwithwhichyourofficerswereinvolvedduringthelastthree(3)yearseverbeeninbankruptcyoravoluntaryorinvoluntaryreorganization?
o
Yes
o
NoIfyes,attachacompleteexplanation.
AnnualVolume
Whatwastheaverageannualrevenuefromworkcompletedinthelastthree(3)yearsand,whatisnextyear'sforecastedrevenue?YearYearYearForecastedrevenuenextyearRevenueRevenueevenue
formorethanaattachofyourmostrecentannualfinancialstatementsincomestatementandcashflow).Ifyourannualstatementsaremorethansixmonthsold,alsoincludecurrentquarterlystatements.Kitchellusesthisinformationstrictlyforpre-qualificationpurposesandwillnotdiscloseyourfinancialinformationtoanythirdAilforminformationandattachmentsuseSSLwhensubmitted.
OSHARecord
HasyourfirmhadanyOSHAcitations.finesorjobsttefatalitieswithinthemostrecentthree(3)years?
o
Yes
0
NoIfyes,pleaseattachadetaileddescriptionoftheincidentandthestepstakentopreventarecurrence.
Workers'Compensation
Pleaselistyourfirm'sworkers'compensationexperiencemodificationrate(EMR)forthelastthree(3)years.Year
I
:=::=~
Rate
L__----'
YearYearRateRate
 
SubcontractorPre-qualification
page
3
o
Yes
o
NoasyourcompanyimplementedaTotalQualityManagement(TQM)system?Doyouhaveawrittenmanual?
o
Yes
TradeCategories
Selecttheprimarycategoriesofworkyouwouldnormallyperform.
I
PrimaryCategoryofWork
o
Upto$250K
o
Upto$500K
o
$1M
o
$5M
o
$5M+referredcontractsizeHasyourcompanyhadexperiencewithLEED-certifiedprojects?
o
Yes
o
No
GeographicAreasofWork
Pleasecheckonlylocationsinwhichyouwanttobid.
o
NorthernArizona
0
CentralArizona
0
SouthernArizona
0
Colorado
0
Utah
o
NewMexico
o
NorthernCalifornic
0
CentralCalifornia
0
SouthernCalifornia
0
Nevada
0
Hawaii
o
Oregon
o
Other[~
o
Other._[_"";_--'Other
._I__--'
Attachalistofanyotherbranchofficelocations.
ProjectTypes
Pleasecheckthetypeofbuildingprojectsyourcompanyhascompleted.
o
HealthCare
o
Casinos
o
CorrectionalFacilities
o
CustomHomes
o
AssistedLiving
o
Industrial
o
Schools
o
Other
~
o
Hospitality
o
Retail
o
Infrastructure
o
Other
I
o
Clubhouse/Spa
o
Office
o
Multihousing/Dorms
o
Other
~
ContractMethod
Pleaseindicatethepercentageofyourworkloadforeachcontractmethod.
%
CompetitiveBid
%
Negotiated/DesignAssist
%
DesignBuild

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