Project Name:

Sundt Contact:

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SUBCONTRACTOR

PRE-QUALIFICATION STATEMENT

Overview: SubQual, LLC provides prequalification services on subcontractors that wish to be included in the bid list of Sundt Construction, Inc. It is their policy to prequalify the subcontractors prior to bidding on any of their projects. From the information provided, they will independently establish the maximum per project contract limit for subcontractors. Establishment of this maximum subcontract value is a requirement of the subcontractor default insurance carrier of this general contractor. (Subcontractor default insurance is provided in-lieu of a bond on the subcontractor.). Your prequalification status must be updated annually.

Questions can be directed to our Pre-qualification Department at (800) 407-6192 or E-Mail to .

This statement can be downloaded as a Word document or prepared and submitted on-line in our Subcontractor Portal at www.subqual-llc.com.

Please complete as it appears on your State Contractor’s License:Legal Name of Firm:
DBA:
Address:
(city, state, zip)
State: License No: Class(es): Expiration:
State: License No: Class(es): Expiration:
State: License No: Class(es): Expiration:
State: License No: Class(es): Expiration:

Shipping Address:

(city, state, zip)

Mailing Address:

(city, state, zip)

Phone: Fax:

Web Address:

Provide names and titles of your firm’s principal contacts:

PRINCIPAL CONTACT: TITLE:

Phone: Fax:

E-Mail:

ESTIMATING CONTACT: TITLE:

Phone: Fax:

E-Mail:


indicate the area(s) that you prefer to work in:

Northern Arizona (including Phoenix and Casa Grande metro areas)

Southern Arizona (including Tucson and Yuma metro areas)

Northern California (including Sacramento metro areas)

Southern California (Los Angeles and San Diego metro areas)

Nevada (including Reno metro areas)

Texas: El Paso North Texas Texas Panhandle Southeast Texas South/Central Texas West Texas

Federal Work – list states ______

List CSI Divisions/Trades (see page 5):

Are you willing to bid on prevailing wage projects? Yes No

For Arizona subcontractors only, please answer the following two questions:

Do you comply with all federal immigration lawsper A.R.S. 41-4401? Yes No

Do you use the E-Verifyprogram (A.R.S. 23-214, subsec. A)? Yes No

Your Company’s Minority Status:

Please check all that may apply and provide proof of certifications*:

County, City, State and Transportation Departments:

DBE Disadvantaged Business Enterprise*

DVBE……………Disabled Veterans Business Enterprise*

MBE Minority Business Enterprise*

SBE Small Business Enterprise*

WBE Woman Business Enterprise*

Federal Contracts (DoD) / Small Business Administration:

(Small Disadvantaged Businesses and HubZone Businesses must be certified by the SBA and registered in the CCR /Pro-Net system. For more information visit www.ccr.gov)

HBCU/MI Historically Black Colleges Universities/ Minority Institutions*

HUBZone-SB Historically Underutilized Business Zone*

LB Large Business

SB Small Business*

SBA 8(a) Small Business Administration 8(a)*

SDB Small Disadvantaged Business*

SD-VOSB Service Disabled Veteran Owned Small Business*

VOSB Veteran Owned Small Business*

WOSB Women Owned Small Business*

Minority Ownership

Native American (includes American Indian, Eskimo, Aleut & Native Hawaiian)

ANC-LB…………Alaskan Native Corporation and Indian Tribes – Large Business

ANC………...…..Alaskan Native Corporation and Indian Tribes

annual largest single general

year sales contract value contractor

2009 / $ / $
2008 / $ / $
2007 / $ / $

Safety: List Experience Modification Rate 2009 2008 2007

Federal Tax ID:

Dunn & Bradstreet Number:

Current Bonding and Banking Information:

Surety Company: Broker:

Contact Person: Phone:

Name of your bank:

Address:

Contact Person: Phone:

Line of credit: $ Unused portion: $ Expiration date:

References:

List three major suppliers:

Company Name:

Address:

Phone: Fax:

Contact:

Company Name:

Address:

Phone: Fax:

Contact:

Company Name:

Address:

Phone: Fax:

Contact:

List three General Contractors:

Company Name:

Address:

Phone: Fax:

Contact:

Company Name:

Address:

Phone: Fax:

Contact:

Company Name:

Address:

Phone: Fax:

Contact:

IN ORDER TO BE PREQUALIFIED FOR MORE THAN $50,000, THE FOLLOWING MUST BE PROVIDED ANNUALLY:

·  A letter from your Surety outlining the single project and aggregate amounts for which they will issue a performance and payment bond (we are not asking for a bond).

·  A copy of your latest (consolidated) financial statements, i.e., Balance Sheet, Income Statement, etc., prepared by an outside accounting firm (Audited, Reviewed or Compiled Financial Statements) AND a copy of your most recent internal financial statements.

v  Please be assured your financial information will be kept confidential in accordance with our Subcontractor Portal Privacy Statement. For more information see www.subqual-llc.com.

v  Your pre-qualification status cannot be determined until the pre-qualification statement is accurately completed, a letter from your surety is received and the necessary financial statements are provided.

By signing the SubQual, LLC Subcontractor Pre-Qualification Statement (“Statement”) you authorize the release of the submitted information as set forth in the Statement to Sundt Construction, Inc. (“Sundt”). This information will be used by Sundt to independently establish the maximum per project contract limit for your company. Please note, the actual financial statements you provide to SubQual are kept confidential and are not open to the GC or any other party unless SubQual receives written permission from an officer of your company.

Completed by:

Title:

Phone number:

Email:

Date:

SUBMIT SubQual, LLC Or by Confidential Fax:

TO: Attn: Pre-Qualification Department (800) 407-6194

P.O. Box 80577 Or by Confidential E-mail:

San Diego, CA 92138

CSI Divisions/Trades:

(Please circle or check the trade(s)that your company is interested in bidding)

1000 / General Conditions / 5810 / Expansion Joint Covers / 11130 / Audio-Visual Equipment
1140 / Survey & Layout / 6110 / Wood Framing / 11150 / Parking Control Equipment
1400 / Material Testing / 6250 / Prefinished Paneling / FRP / 11160 / Loading Dock Equipment
1430 / Security Guard Firms / 6400 / Architectural Woodwork / 11170 / Solid Waste Handling Equipment
1435 / Chemical Toilets / 6415 / Countertops / 11190 / Detention Equipment
1440 / Cleaning Services / 6500 / Structural Plastics / 11200 / Water Treatment Equipment
1480 / Jobsite Trailers / 6600 / Plastic Fabrications / 11210 / Supply/Treatment Pumps
1530 / Temporary Fencing / 7100 / Dampproofing/Waterproofing / 11220 / Mixers And Flocculators
2110 / Excav., Removal, Haz. Matl / 7160 / Cementitious & Reactive W.P. / 11225 / Clarifiers
2115 / U.G Storage Tank Removal / 7170 / Bentonite Waterproofing / 11230 / Water Aeration Equipment
2145 / Groundwater Treatment Sys. / 7180 / Traffic Coatings / 11240 / Chemical Feed Equipment
2210 / Subsurface Investigation / 7210 / Building Insulation / 11250 / Water Softening Equipment
2220 / Demolition / 7240 / Exterior Insul. Finish Syst. / 11260 / Disinfectant Feed Equipment
2250 / Shoring And Underpinning / 7410 / Metal Roof And Wall Panels / 11270 / Fluoridation Equipment
2300 / Earthwork / 7510 / Built-Up Bituminous Roofing / 11285 / Hydraulic Gates
2310 / Asphalt Paving / 7570 / Coated Foamed Roofing / 11295 / Hydraulic Valves
2360 / Soil Treatment / Termite Cntrl / 7620 / Sheet Metal Flashing/Trim / 11300 / Waste Treatment/Disposal Equip.
2455 / Driven Piles / 7720 / Roof Accessories / 11310 / Sewage And Sludge Pumps
2475 / Caissons / 7810 / Applied Fireproofing / 11320 / Grit Collecting Equipment
2500 / Site Utilities / 7920 / Joint Sealants / 11330 / Screening/Grinding Equipment
2620 / Drywells / 8110 / Steel Doors And Frames / 11335 / Sedimentation Tank Equipment
2632 / Storm Drainage / 8210 / Wood Doors / 11340 / Scum Removal Equipment
2660 / Ponds And Reservoirs / 8300 / Specialty Doors / Won Doors / 11345 / Chemical Equipment
2770 / Curbs And Gutters / 8320 / Detention Doors And Frames / 11350 / Sludge Hand./Treatment Equip.
2780 / Unit Pavers / 8360 / Overhead Doors / 11360 / Filter Press Equipment
2790 / Athletic/Recreation Surfaces / 8460 / Automatic Entrance Doors / 11365 / Trickling Filter Equipment
2815 / Fountains / 8500 / Windows / 11370 / Compressors
2820 / Fences And Gates / 8600 / Skylights / 11375 / Aeration Equipment
2830 / Retaining Walls / 8700 / Hardware / 11380 / Sludge Digestion Equipment
2840 / Striping / 8800 / Glazing / 11385 / Digester Mixing Equipment
2870 / Site Furnishings / 8950 / Translucent Wall/Roof Assem. / 11390 / Pkg. Sewage Treatment Plants
2890 / Traffic Signs And Signals / 9210 / Cement Plaster / 11400 / Food Service Equipment
2895 / Markers And Monuments / 9250 / Gypsum Board / 11600 / Laboratory Equipment
2900 / Planting, Landscape & Irrig. / 9310 / Ceramic Tile / 11650 / Athletic and Recreation Equipment
2905 / Native Plant Salvage / 9400 / Terrazzo / 12310 / Manufactured Metal Casework
3150 / Concrete Accessories / 9510 / Acoustical Ceilings / 12320 / Manufactured Wood Casework
3200 / Concrete Reinforcement / 9650 / Resilient Flooring / 12490 / Window Treatments
3300 / Cast-In-Place Concrete / 9670 / Fluid Applied Flooring / 12600 / Systems Furniture
3400 / Pre-Cast Concrete / 9680 / Carpet / 13110 / Cathodic Protection
3520 / L.W. Conc. Roof Insulation / 9900 / Paints And Coatings / 13120 / Pre-Engineered Structures
3530 / Gypsum Concrete / 10115 / Markerboards / 13150 / Swimming Pools
4000 / Masonry / 10160 / Metal Toilet Compartments / 13200 / Storage Tanks
4400 / Stone / 10200 / Louvers And Vents / 13230 / Digester Covers/Appurtenances
4720 / Cast Stone / 10260 / Wall And Corner Guards / 13280 / Hazardous Material Remediation
4910 / Unit Masonry Restoration / 10270 / Access Flooring / 13400 / Measurement/Control Instrument
5120 / Structural Steel / 10300 / Fireplaces And Stoves / 13700 / Security Access/Surveillance
5140 / Structural Aluminum / 10350 / Flagpoles / 14200 / Elevators
5150 / Wire Rope Assemblies / 10400 / Identification Devices / 14300 / Escalators And Moving Walks
5200 / Metal Joists / 10430 / Exterior Signage / 14550 / Conveyors
5300 / Metal Deck / 10500 / Lockers / 14600 / Hoists And Cranes
5330 / Aluminum Deck / 10520 / Fire Protection Specialties / 15300 / Fire Protection Piping
5510 / Metal Stairs And Ladders / 10550 / Postal Specialties / 15400 / Plumbing Fixtures/Equipment
5520 / Handrails And Railings / 10605 / Wire Mesh Partitions / 15700 / Heating, Ventilating, A/C Equip.
5530 / Gratings / 10650 / Operable Partitions / 15935 / Building Systems Controls
5560 / Metal Castings / 10705 / Exterior Sun Control Devices / 16000 / Electrical
5650 / Railroad Track/Accessories / 10800 / Toilet, Bath, Laundry Access. / 16700 / Communications
5700 / Ornamental Metal / 10880 / Scales

SubQual, LLC Subcontractor Prequalification Web Form, rev. 09/07/10 Page 1 of 5