SUB-CONTRACTOR PRE-QUALIFICATION FORM

Transcription

1 CONTACT INFORMATION Company Contact Person: Title: Street Address: Suite No.: EXPERIENCE City: Zip: 1. Please check the CSI Codes applicable to your business: Existing Conditions Assessment Subsurface Investigation Demolition And Structure Moving Site Remediation Contaminated Site Material Removal Water Remediation Facility Remediation Concrete Concrete Forming And Accessories Concrete Reinforcing Cast-In-Place Concrete Precast Concrete Cast Decks And Underlayment Grouting Mass Concrete Concrete Cutting And Boring Masonry Unit Masonry Stone Assemblies Refractory Masonry Corrosion-Resistant Masonry Manufactured Masonry Metals Structural Metal Framing Metal Joists Metal Decking Cold-Formed Metal Framing Metal Fabrications Decorative Metal Wood, Plastics, And Composites Rough Carpentry Finish Carpentry Architectural Woodwork Structural Plastics Plastic Fabrications Structural Composites Composite Fabrications Thermal And Moisture Protection Waterproofing Thermal Protection Weather Barriers Steep Slope Roofing Roofing And Siding Panels Membrane Roofing Flashing And Sheet Metal Roof And Wall Specialties Fire And Smoke Protection Joint Protection Openings Doors And Frames Specialty Doors And Frames Curtain Walls Windows Roof Windows And Skylights Hardware Glazing Louvers And Vents Finishes Plaster And Gypsum Board Tiling Ceilings Flooring Wall Finishes Acoustic Treatment Painting And Coating Specialties Information Specialties Interior Specialties Fireplaces And Stoves Safety Specialties Storage Specialties Exterior Specialties Other Specialties

2 Equipment Vehicle And Pedestrian Equipment Security, Detention & Banking Equip Commercial Equipment Residential Equipment Food Service Equipment Educational And Scientific Equipment Entertainment Equipment Athletic And Recreational Equipment Healthcare Equipment Collection And Disposal Equipment Other Equipment Furnishings Art Window Treatments Casework Furnishings And Accessories Furniture Multiple Seating Other Furnishings Special Construction Special Facility Components Special Purpose Rooms Special Structures Integrated Construction Special Instrumentation Conveying Equipment Dumbwaiters Elevators Escalators And Moving Walks Turntables Scaffolding Other Conveying Equipment Fire Suppression Water-Based Fire-Suppression Systems Fire-Extinguishing Systems Fire Pumps Fire-Suppression Water Storage Plumbing Plumbing Piping And Pumps Plumbing Equipment Plumbing Fixtures Pool And Fountain Plumbing Systems Gas And Vacuum Systems HVAC Facility Fuel Systems HVAC Piping And Pumps HVAC Air Distribution HVAC Air Cleaning Devices 2. Please list Licenses & License Numbers you hold: Central Heating Equipment Central Cooling Equipment Central HVAC Equipment Decentralized HVAC Equipment Integrated Automation Electrical Medium Voltage Electrical Dist Low Voltage Electrical Distribution Electrical Power Generating Electrical & Cathodic Protection Lighting Communications Structured Cabling Data Communications Voice Communications Audio-Video Communications Distributed Communications Electronic Safety And Security Electronic Access Control Electronic Surveillance Electronic Detection And Alarm Electronic Monitoring & Control Earthwork Site Clearing Earthwork Methods Shoring And Underpinning Excavation Support & Protection Special Foundations Tunneling And Mining Exterior Improvements Bases, Ballasts, And Paving Site Improvements Wetlands Irrigation Planting Utilities Water Utilities Wells Sanitary Sewerage Utilities Storm Drainage Utilities Fuel Distribution Utilities Hydronic & Steam Energy Utilities Electrical Utilities Communications Utilities Transportation Guideways/Railways Traction Power Fare Collection Equipment Bridges

3 3. Check the building type and size your company has experience with: BUILDING TYPE Federal Airports Healthcare Educational Office Retail 4. Please indicate the highest construction value your company wishes to be considered for (Keep in mind you must be able to bond the amount indicated below) $0,00 - $25,0000 $25,000 - $50,000 $50,000 - $150,000 $150,000 - $250,000 $250,000 - $500,000 Over $500, List the 3 most important projects your company has completed in the past 3 years: 6. Indicate the Total $ Amount of Uncompleted work: 5. List the 3 most important projects your company has in progress at the moment: 1. How long has your company been in operations? 0-5 years 5-10 years over 10 years 2. How is your company organized: Sole Proprietorship Partnership Corporation Joint Venture Other: 3. If applicable, State of Incorporation: PROJECT SIZE Less than $100,000 Over $250,000 Over $500,000 Project Name Cost End Date Owner Project Name Cost End Date % Complete Owner CORPORATE & FINANCIAL INFO 4. What is your Federal Tax ID Number:

4 5. List the names of the 3 top officers in your company: Title: Title: Title 6. Does your company operate under any other name: 7. Is your company affiliated with any other company? Address: Relationship: 8. Surety Information Surety Company: Bonding Agent: Single Capacity: Aggregate Capacity: 9. Insurance Information Insurance Company: Insurance Agent: 10. Check your Company s Areas of Operations: South Florida Central Florida All Florida South East US Other: 11. Check the Categories that Apply to your firm: Large Business Small Business 8(a) HUB Zone Women-Owned Business Service-Disabled Veteran Alaska-Native MDC CSBE Level 1 MDC Level 2 CSBE Level 3 Florida DBE Other:

5 12. Please indicate which type of work does your firm Self-Perform: Electrical Mechanical Fire Protection Sheet Metal Roofing Earthwork Demolition Asphalt Masonry Drywall Painting Other: 13. What percentage of the work do you typically Self-Perform: 14. Please indicate the number of people your company currently employs: Office: Field: 15. Have you ever failed to complete any project awarded to you? Yes No 16. Indicate the yearly volume of work awarded to your firm for the past 3 years: 2009: 17. Please include the following Financial Information. Date of Statement: Retained Earnings: Current Assets: Current Liabilities: REFERENCES 1. List 3 Trade References 1. Indicate you EMR (Experience Modification Rate) for the past 3 years: 2009: 2010: 2010: Net Worth: 2. Do you conduct Safety Inspections? Yes No Who conducts the safety inspections? How Often? 2011: Contact Name/Title Company Phone Number Address 2. Provide 1 Banking Reference Contact Name/Title Bank Name Phone Number Address SAFETY RECORD & PROGRAM 2011: 3. Do you have a written Safety Program? Yes No

6 3. Do you have a safety orientation program for new employees in place? Yes No 4. Do you have a Drug & Alcohol Policy in place? Yes No 5. Do you conduct Toolbox Safety Meetings? Yes No How Often? All information submitted is held in strict confidence. By clicking in the box you hereby certify that all the foregoing statements contained herein are true and correct.