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Pre-Qualification Form

SUB-CONTRACTOR PRE-QUALIFICATION FORM

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Company Information

Legal Company Name*

Contractor License Number*

Address, City, State, Zip Code*

Phone #*

Email*

Website

FAX #

DIR #*

Years In Business*

Average Annual Volume (3 Yrs)*

EIN / Federal ID #*

DUNS #*

NAICS Codes

Trades Performed*

Company Organization Type*

Individual / Sole Proprietorship

Partnership

Corporation

Date of Incorporation / Organization*

State of Incorporation / Organization*

Name of Principals*

Is your company apart of a Union?*

Signatory Unions

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Point of Contact Information

POC Name*

POC Title*

POC Direct Phone / Mobile #*

POC Email*

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Business Operations Information

Type of Construction*

Government

Commercial

Medical

Retail

Industrial

Educational

Tenant Improvement

Core & Shell

Other

Other Construction:

Company Area of Operation*

Fresno County

San Joaquin Valley

Northern California

Southern California

Statewide ( California )

Nevada

Oregon

Arizona

Other

Other Locations:

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Safety Information

Safety Director / Officer*

Experience Modification Rate (EMR)*

OSHA Days Away from Work, Restricted Duty, or DART Rate*

Do you have a Written Safety Plan?*

Yes

No

Has your firm been cited for OSHA violations in the past (3) years?*

Violations & Corrective Actions

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Bonding & Reference Information

General Contractor References*

Bank References

Bonding Information*

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Business Classifications / Set-Asides

Business Classification*

Small Business

DBE

HUBZone

WOSB

SDVOSB

VOSB

ANC/Tribally Owned Corporation

Large Business

Other

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If the answer is Yes to any of the questions below, please attach details.

Has your firm ever defaulted on a contract?

Yes

No

Has your firm experienced reorganization within the past year?

Yes

No

Are there any judgments, claims, arbitrations proceedings or suits pending against your organization or its officers?

Yes

No

Has your organization filed any lawsuits or requested arbitration with regard to construction contracts in the last five (5) years?

Yes

No

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Sub-Contractor Pre-Qualification Form

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4717 E Hedges Ave, Fresno, CA 93703

(559) 276-7726

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