D.L. PORTER CONSTRUCTORS, INC.

6574 Palmer Park Circle, Sarasota, FL34238

Office 941-929-9400 - Fax 941-929-9500

SUBCONTRACTOR PREQUALIFICATION FORM

Firm: Telephone ( )

Address: Fax ( )

Contacts in Firm for Estimating: Title:

Spec Sections generally quoted:

Years in Business under present name: (years)Former Business Name:

Work now under Contract:$ Total Bonding Capacity: $

Bonding Surety:

Bonding Agent: Phone ( )

Insurance Agent:______Phone (__)______

Average Annual Sales (last 3 years): $______Percent of Work Performed by own forces:______(%)

Total number of permanent staff currently employed by firm:______

(Do Not Include Contract Labor) Field:______Office:______

Is the firm in compliance with EEO requirements? ______Yes ______No

Approximate value of equipment owned by firm: $______

Bank references, contacts, phone numbers and addresses:______

______

______

Has the firm ever failed to complete a contract?_____ Yes _____ No

Has any officer or principal of the firm been involved in bankruptcy or reorganization?_____ Yes _____ No

Does the firm have any pending judgments, claims or suits against the firm?_____ Yes _____ No

(If the answer to any of the preceding questions is “yes”, submit details on a separate sheet and attach.)

List three (3) current suppliers, with contact name, phone number and address:

1)______

2)______

3)______

List below the three (3) most significant projects completed in the last three (3) years:(attach additional sheets if necessary)

Project & Location:______

General Contractor:______

Contracted w/______Contact/Phone No.:______

Amount: $______Date Complete:______

Project & Location:______

General Contractor:______

Contracted w/______Contact/Phone No.:______

Amount: $______Date Complete:______

Project & Location:______

General Contractor:______

Contracted w/______Contact/Phone No.:______

Amount: $______Date Complete:______

List below the three (3) most significant projects presently under construction:(attach additional sheets if necessary)

Project & Location:______

General Contractor:______

Contract w/______Contact/Phone No.:______

Amount: $______Projected Completion Date:______

Project & Location:______

General Contractor:______

Contracted w/______Contact/Phone No.:______

Amount: $______Projected Completion Date:______

Project & Location:______

Contractor:______

Contracted w/______Contact/Phone No.:______

Amount: $______Projected Completion Date:______

LEED Experience (Summarize Scope of Work, use separate sheet if necessary):

FINANCIAL STATEMENT: (A current Financial Statement is required. If the Financial Statement is more than six {6} months old, include a current balance sheet.)

Firm preparing Statement(s):______

State License No: ______(Attach copy)

Federal Tax ID#: ______

Minority Business Certifications: NumberIssuing Agency

(if applicable, include certificate copy)______

I hereby certify that the above information is true and complete to the best of my knowledge.

Signature:______(__ ) Corporation______

(State)

Name:______(__) Partnership

(Print or Type Name)

Title:______(___) Sole Proprietor

(___) Joint Venture(Submit separate forms for each member of the Joint Venture)