Subcontract Pre-Qualification Worksheet
Please complete the enclosed subcontractor pre-qualification questionnaire to help us better understand your companies’ operations, capabilities, safety records, and experience. Upon completion please forward a copy of your W9, Certificate of Insurance, and all required attachments to our Administrative Department via E-Mail or Fax. (E-Mail: or Fax: 972.501.9779)
COMPANY INFORMATION:
Company Name: ______
Address: ______
Phone: Fax: ______
Estimating Contact: ______
Estimating E-mail Address:
Estimating E-mail Address:
Project Management Contact(s): ______
Principal(s): ______
CSI Code/Trade: ______
What size projects do you prefer? ______
How long has your firm been in business under its present name? ______
Federal Employer ID #: ______Contractors License Number: ______
How many total employees do you have? How many are field employees? ______
Geographic range of service: ______
Are you a Minority or Women-Owned Business? ______If yes, provide certification number______
Has your firm gone through an ownership change in the last twelve (12) months? ______
If yes, please explain: ______
PERFORMANCE INFORMATION:
Has an owner or general contractor terminated your contract for cause in the last five (5) years? ______
If yes, please explain: ______
Has your company failed to complete any construction contracts in the last five (5) years? ______
If yes, please explain: ______
Provide 5 supplier or financial trade references as an attachment to this form, including company name, address, contact name, and phone and fax number:
Provide the firm name, contact name and phone number of the general contractor along with the contract amount for 3 of your current projects:
Project 1 Project 2 Project 3
Project Name ______
Contract Value ($) ______
GC Firm Name ______
GC Contact Name ______
GC Phone # ______
Surety Broker/Agent Phone #: ______
Bond Capacity: Per Job $______Aggregate $ ______Bond Rate (per thousand):______
Insurance Information & Qualifications –
Please attach the following information:
Resumes of key personnel or outline of experience in this trade.
Reference list (Clients, General Contractors, Suppliers).
Current certificate of insurance detailing the following minimum coverage:
Workman’s Compensation: As required by law.
General Liability: $1,000,000 each occurrence; $2,000,000 aggregate combined single limit of
liability including projects and completed operations.
Automobile Liability: $500,000 combined single limit of liability including hired and non-owned
coverage.
Please attach a copy of your Certificate of Insurance listing Highland Builders, Inc., as the Certificate Holder and as additionally insured.
SAFETY INFORMATION:
Provide your EMR rating for the last three (3) years: 2014 2013 2012
______
In the last five (5) years, has your company been cited by OSHA for a “serious” or “willful” violation?______
If yes, please explain: ______
Provide a copy of your current OSHA 300 log as an attachment to this form.
Does your company have a written safety program in place? ______
If awarded contracted work a safety program manual must be provided to HBI.
Does your company have a training program for all employees in place? ______
I certify that the information provided in this application and the attached material is true and sufficiently complete so as not to be misleading.
Signature: Date: ______
Printed Name: ______