8825 Rehco Rd.

, Suite A
San Diego, CA 92121
(858) 657-9186 Tel
(858) 657-0914 Fax

SUBCONTRACTOR PREQUALIFICATION FORM

COMPANY/CONTACT INFORMATION:

Company Name: Date: _

Address: ______

Phone #: ______ Fax #:

Contact Name: ______ E-mail:

Estimating Contact: ______ E-mail:

Contractor’s License #: ______ Website:

Type of Company: Corporation Partnership Sole Proprietorship

Federal Tax ID #: ______ Year Established:

Is your Company certified? MBE WBE SBE DBE DVBE LSDBE

Certifying Agency: _______

Where are you licensed to do business?: _______

Number of Employees: Office Field

Can you use programs that open plans, such as: AutoCad Acrobat (PDF)
Other (Specify):

Trade(s) performed: _______

Does your Company have any union agreements? Yes No

If yes, please list: ________

Average value of work completed during the last five years: $

Average project size completed last year: $

Value of work currently under contract: $ Uncompleted backlog: $

Size of projects preferred (Minimum): $ Maximum: $

Do you have a written Company Safety Policy and Program? Yes No

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BSD Builders, Inc. Subcontractor Prequalification Form

Will you provide copies if requested? Yes No

Workers Compensation Experience Modification Rate (EMR) for the past 3 years:

Current: 1st Prior Year: 2nd Prior Year:

Are you able to bond projects? Yes No Bonding Rate: %

Single Project Limit: Aggregate Limit:

Do you have the ability to print plans within your office from an online source? Yes No

PROJECT INFORMATION:

List four representative projects completed within the last five years:

Name of project: _______

Contracting Company: ________
Contact Name : Phone #: ________
Contract Amount: Completion Date: ______
OSHPD Project: Yes No

Name of project: _______

Contracting Company: ________
Contact Name : Phone #: ________
Contract Amount: Completion Date: ______
OSHPD Project: Yes No

Name of project: _______

Contracting Company: ________
Contact Name : Phone #: ________
Contract Amount: Completion Date: ______
OSHPD Project: Yes No

Name of project: _______

Contracting Company: ________
Contact Name : Phone #: ________
Contract Amount: Completion Date: ______
OSHPD Project: Yes No

Geographical areas serviced:

San Diego County Orange County

Riverside County Los Angeles County

INSURANCE INFORMATION:

Every job requires project specific certificates of insurance with BSD Builders, Inc. listed as an
additional insured with the following endorsements attached:
 Primary Wording
 Per Project Aggregate
 Form B

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BSD Builders, Inc. Subcontractor Prequalification Form

 General Liability Waiver of Subrogation

 Workers Compensation Waiver of Subrogation

Please include a copy of your certificate(s) of insurance.

Additional costs incurred for the above referenced endorsements are to be included in your bid.

FINANCIAL INFORMATION:

Trade References:

Company Address Contact Telephone No.

1.

2.

3.

Bank References:

Lender Address Contact Telephone No.

1.

2.

Does your Company have a line of credit from any lending institution? Yes No

Line: $ Average amount utilized: $

MISCELLANEOUS INFORMATION:

In the past 5 years, has your Company

1. had any liens filed against it by any of its subcontractors or suppliers? Yes No
2. failed to complete a contract, been defaulted or had a contract Yes No
terminated?
3. had liquidated damages assessed against it upon completion of a job? Yes No
4. or any of its key people been a party to a bankruptcy or reorganization Yes No
proceeding?
5. or any of its key people been involved in a lawsuit arising from a job? Yes No
6. or any of its key people been investigated for or found to have Yes No
committed a violation of any labor laws?
7. or any if its key people been investigated for or been cited for a Yes No
serious OSHA violation?

Attach details for any “Yes” answer.

Email completed forms to

info@bsdbuilders.com or
3 of 3 fax to 858.657.0914.