SUBCONTRACTORS

Legal Business Name *

DBA (if applicable)

Business Address *

Year Company Established *

Business Entity Type *
LLCCorporationSole ProprietorPartnershipOther

Federal Tax ID (EIN) *

Website (optional)

Business Designation
—Please choose an option—Minority-Owned Business (MBE)Women-Owned Business (WBE)Veteran-Owned Business (VBE)Service-Disabled Veteran-Owned (SDVBE)NonePrefer not to say

Full Name *

Title / Role *

Office Phone *

Email Address *

This contact will be reached when new project opportunities arise. May be the same as primary contact.

Full Name *

Title / Role *

Cell Phone *

Email Address *

Best Time to Reach
—Please choose an option—Morning (8am-12pm)Afternoon (12pm-5pm)Evening (after 5pm)Anytime

Trade(s) Performed *

Describe Your Scope of Work in Detail *

Years in Business *

Geographic Coverage *

Do You Self-Perform Work? *
Yes -- fully self-performPartially -- mix of self-perform and subNo -- we sub all field work

Are You Currently Bonded? *
YesNo

Maximum Bonding Capacity

Types of Facilities Worked In *

IndustrialCommercialWarehouse/DistributionManufacturingHealthcareFederal GovernmentRetailEducationOther

Largest Single Project Completed *

Experience in Live Plant / Active Facility Projects? *
YesNo

If Yes -- Describe Your Live Plant Experience

Experience on Federal Government Projects? *
YesNo

If Yes -- List Relevant Certifications or Clearances

Experience with OSHA 1910 / General Industry Standards? *
YesNo

Experience in Hazardous Material Environments?
—Please choose an option—YesNo

Experience Working Under a General Contractor? *
YesNo

Ever Had a Project Terminated or Contract Defaulted? *
NoYes -- please explain below

If Yes -- Please Explain

Written Safety Program? *
YesNo

EMR Rate (Experience Modification Rate)

OSHA 300 Log -- Recordable Incidents (Last 3 Years)? *
No recordable incidentsYes -- incidents occurred

If Yes -- Please Describe Incidents

OSHA Certifications Held *

Regular Safety Training for Employees? *
Yes -- formal scheduled trainingYes -- informal / as-neededNo

Number of Full-Time Employees *

Number of Field / Craft Employees

General Liability Coverage Amount *

Workers Compensation Coverage *

Umbrella / Excess Liability (if applicable)

Name of Insurance Provider *

Upload Certificate of Insurance (PDF preferred) *

Upload Completed W-9 Form *

Download a blank W-9 at irs.gov/pub/irs-pdf/fw9.pdf

Contractor License Number (optional)

Upload Contractor License (optional)

This information helps match you to appropriately sized projects. All financial information is strictly confidential.

Annual Revenue (approximate range)
—Please choose an option—Under $500K$500K - $1M$1M - $5M$5M - $10MOver $10M

Established Accounts Receivable Process?
—Please choose an option—YesNo

Typical Payment Terms You Require (A/R)
—Please choose an option—Net 30Net 45Net 60Other

A/P Process for Your Subs / Suppliers?
—Please choose an option—YesNo

Existing Line of Credit?
—Please choose an option—YesNoPrefer not to answer

Primary Bank (for reference)

Strongly recommended -- providing at least 3 references significantly strengthens your application. References are not required to submit.

Reference 1

Facility / Company Name

Contact Person

Phone and Email

Project Description

Year Completed

Approximate Project Value

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Reference 2

Facility / Company Name

Contact Person

Phone and Email

Project Description

Year Completed

Approximate Project Value

---

Reference 3

Facility / Company Name

Contact Person

Phone and Email

Project Description

Year Completed

Approximate Project Value

---

Reference 4 (optional)

Facility / Company Name

Contact Person

Phone and Email

Project Description

Year Completed

Approximate Project Value

Upload Capability Statement or Company Brochure

Pre-Qualified with Other General Contractors? If Yes, List Them

Additional Comments or Information