Subcontractors • Subcontractor Qualification Form

QUALIFICATION FORM

All information must be completed in order to be considered for pre-qualification.
- Please return completed form, along with a current financial statement

SUBMITTED BY

CONTACT PERSON

EMR RATING FOR THE LAST THREE (3) YEARS

TYPE OF BUSINESS

TYPE OF WORK

PLEASE CHECK ALL THAT APPLY

Union

Small Business Administration (SBA)

8A - Federal Certificate

Minority Business Enterprise (MBE)

Women Business Enterprise (WBE)

Veteran's Business Enterprise (VBE)

A. ORGANIZATION

1. Number of years in business as a contractor?

2. Number of years in business uner your present business name?

3. What other names has your business operated under?

You must complete at least one of the following (4-7)
4. If your organization is a corporation, answer the following:

5. If your organization is a partnership, answer the following:

6. If your organization is individually owned, answer the following:

7. If your organization is different then those listed above, describe it then name the principals

B. LICENSING

1. List jurisdiction and trade categories in which your organization is legally qualified to do business, and indicate registration or license numbers, if applicable

2. List jurisdiction in which your organization's partnership or trade name is filed

C. EXPERIENCE

1. List the categories of work that your organization normally performs with its own forces

2. Claims and Suits
(if the anser to any of the questions below is yes, please attach details)
A. Has your organization ever failed to complete any work awarded to it?


B. Are there any judgments, claims, arbitration proceedings or suits pending or
outstanding against your organization or its officers?


C. Has your organization filed any lawsuits or requested arbitration with regard to
construction contracts within the last five years?


3. Within the last five years, has any officer or principal of your organization ever
been an officer or principal of another organization when it failed to complete
a construction contract? (If the answer is yes, please attach details)


4. List major construction projects your organization has in progress, giving
the name of the project, owner, architect, contract amount, percent complete
and scheduled completion.

5. State total worth of work in progress and under contract.

6. List the major projects your organizationhas completed in the past five years, giving the name of the project, owner, architect, contract amount, date of completion and percentage of the cost of the work performed with your own forces.

7. State average annual amount of construction work performed during the past
five years.

8. List the construction experience and present commitments of the key individuals of your organization

D. REFERENCES

1. Vendor/Supplier References: (Please list supplier name, address, phone and email. (3) Trade References required.):

2. Bank References:

3. Surety:

4. Name of Bonding Company:

5. Country of Bonding Compnay:

6. Name and address of agent:

7. Financing

E. FINANCIAL STATEMENT

1. Attach a financial statement, preferably audited, including your organization's
latest balance sheet and income statement showing the following items:
A. Current Assets (e.g., cash, joint venture accounts, accounts receivable, notes
receivable, accrued income, deposits, materials inventory and prepaid expenses)
B. Net Fixed Assets
C. Other Assets
D. Current Liabilities (e.g., accounts payable, notes payable, accrued expenses,
provision for income taxes, advances, accrued salaries and accrued payroll taxes)
E. Other Liabilities (e.g., capital, capital stock, authorized and outstanding shares
par values, earned surplus and retained earnings)
F. Name and address of firm preparing attached financial statement, and date
thereof

2. Is the attached financial statement for the identical organization named on page
one?

A. If not, explain the relationship and financial responsibility of the organization
whose financial statement is provided (e.g., parent-subsidiary).

B. Will the organization whose financial statement is attached act as guarantor of
the contract for construction?

F. SIGNATURE

I, certify that the information herein is true and sufficiently complete as not to be misleading.