Subcontractors

Company Information

Company Legal Name

Address

Street Address Address Line 2 City State ZIP Code

Phone Number

Fax Number

Federal ID Number

Duns & Bradstreet Number

Business Type

Parent company, if applicable:

Subsidiaries and Divisions

Year Founded

Website

Number of Field Employees

Number of Office Employees

Number of Field Employees

Number of Non-union Employees

Number of Union Employees

Union Affiliations

Description of Trade/Products Provided

States Where Firm Does Business

Contractor’s License Number(s)

State/City	Classification

Does your company subscribe to any vetting services (i.e. ISNetworld, PICS, PEC Premier, etc.)?

Yes
No

If yes, please list which ones

Officers/Owners

Name	Title	Name Title % of Ownership

Has your firm gone through an ownership change in the past 12 months?

Yes
No

If yes, please explain

Primary points of contact within your organization:

Department	Name	Email	Phone	Fax

Financial Information

Historical financial information (past three years):

Year Ending	Revenue	Ending Backlog

Current Year Projections

Revenue ($)

Current Backlog ($)

Current Number of Projects in Progress

Average Contract Size

Largest Contract in Past 36 Months

Number of LEED Projects Completed

Provide a recent balance sheet.

Max. file size: 256 MB.

All subcontractor pre-qualification questionnaires and balance sheets are held in strict confidence

Name of primary bank:

Bank contact:

Phone Number

Bank Line of Credit

Unused Portion

Are any assets pledged or collateralized?

Yes
No

If yes, how much?

Describe all lawsuits and judgments against your company in the last two years:

Have any of your principals or officers ever filed bankruptcy either personally or for a business they were associated?

Yes
No

If yes, please explain

Surety and Bonding

Surety Company

Surety Broker/Agent

Surety Broker/Agent Phone Number

Bonding Capacity

Per Job

Aggregate

Bond Rate

(Per thousand)

Please provide a letter from your surety confirming your capacity and good standing.

Max. file size: 256 MB.

Insurance Information

Does your company meet the insurance requirements?

Yes
No

If no, please explain.

Please provide a sample of your certificate of insurance with this form.

Max. file size: 256 MB.

Safety Information

Current

Last Year

Two Years Ago

Have you had any OSHA citations in the last 3 years?

Yes
No

If yes, how many?

Provide copies of your OSHA 300 and OSHA 300A logs and EMR letters for the prior three years.

Max. file size: 256 MB.

Do you employ OSHA certified competent person(s)?

Yes
No

If yes, please indicate which areas

Work Experience

Has an owner or general contractor terminated your contract for cause in the last 5 years?

Yes
No

If yes, please explain.

Has your company failed to complete any construction contracts in the past five years?

Yes
No

If yes, please explain.

Provide a list of major construction projects your organization has completed during the past two years or currently in progress. Include name of project, owner, architect, general contractor, contract amount, city/state, and completion date.

Drop files here or

Max. file size: 256 MB.

Provide a list of 5 supplier or financial trade references, including company name, contact name and phone number.

Drop files here or

Max. file size: 256 MB.

Minority Information

(Please check all that apply.)

Certification Status

Not applicable
Public
Self
Private

Address

City State ZIP Code

NMSDC (National Minority Supplier Development Council) Affiliates

Provide a copy of your Minority Certification as an attachment, if applicable.

Max. file size: 256 MB.

Signatures of Subcontractor

Name

Title

Email

Date

Attachments

Drop files here or

Max. file size: 256 MB.

Attachments Included

Balance Sheet (reviewed or audited, or most recent internal month-end)
Surety Reference Letter
Sample Insurance Certificate
Current OSHA 300 and 300A Logs
List of Completed and Active Construction Projects
Minority Certification
Form W-9

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Partnering With Eby Construction

Company Information

Financial Information

Current Year Projections

Surety and Bonding

Bonding Capacity

Insurance Information

Safety Information

Work Experience

Minority Information

Signatures of Subcontractor