PRE-QUALIFICATION QUESTIONNAIRE

Thank you for your interest in Jordon Construction Company (JCC). To better understand the capabilities of your firm and best match you with future JCC opportunities, please complete the form below and email (form and any attachments) to or fax to (864) 715-3052. If all information is not provided, this will significantly delay approval or your prequalification could be rejected. Please note that this is a preliminary prequalification form and includes only our minimum requirements. Additional information may be requested by the job owner or due to the type of work to be performed.

Section I: Business Information

Legal Company Name:______Primary Contact: ______

Federal Tax ID Number: ______(Must be an Officer, Manager or Principal)

Phone: (___)______Direct Line/Cell: (___) ______Fax: (___)______

Email: ______Website: ______

Physical Address: ______City: ______State: ______Zip: ______

Mailing Address: ______City: ______State: ______Zip: ______

Section II: Company Information

  1. What type of company are you? __ Subcontractor __ Supplier __ Engineer __Architect __ Vendor __ Other
  2. Year Company Established: ____ Type of Company: __ Corporation __Partnership __Proprietorship __Sub S Corp __ LLC
  3. Is your company a small business concern, as defined by the Federal Government? __Yes __ No

If yes, do you also fall under any of the following socioeconomic classifications? __ Yes __ No

__ Small Disadvantaged Business__ Historically Black Colleges & Universities __ Veteran Owned

__ Women Owned__ HubZone __ Service Disabled Veteran Owned

__ Alaska Native Corporations/Indian Tribes that have not been certified by the SBA as a Small Disadvantaged Business

__ Alaska Native Corporations/Indian Tribes that are not small business

  1. Is your company classified as one of the disadvantaged businesses listed below: __ Yes __ No

__ Women Business Enterprise__ Minority Business Enterprise__ Disadvantaged Business Enterprise

If yes, what organization are you certified by?______

  1. Current Number of Employees: __ 1-15 __ 16-50 __ 51-100 __ 101-200 __ 201-500 __ More than 501
  2. Current Expected Volume: __ Under $250,000 __ $250,001-$500,000 __$500,001-$1,000,000 __More than $1,000,000

Annual Volume for 2013 __ Under $250,000 __ $250,001-$500,000 __$500,001-$1,000,000 __More than $1,000,000

Annual Volume for 2012 __ Under $250,000 __ $250,001-$500,000 __$500,001-$1,000,000 __More than $1,000,000

Annual Volume for 2011 __ Under $250,000 __ $250,001-$500,000 __$500,001-$1,000,000 __More than $1,000,000

  1. Indicate largest dollar volume contract completed to date. Amount: $______Year: ____ Project Name:______

Description of Scope: ______

  1. Does your firm operate as a Union Shop? __Yes __ NoMerit Shop? __Yes __ No
  2. Indicate the states in which you perform work: ______
  3. If you hold a Contractor’s license, please list the state(s), license number(s), expiration date(s) and other qualifications.
  1. ______
  2. ______
  3. ______
  1. Check all building types on which your Company has worked:

__ Casinos__ Education__ Manufacturing__ Retail

__ Condominiums__ Financial Buildings__ Military__ Sports/Athletic Facilities

__ Convention Centers/Coliseums__ Government/Municipal__ Museums__ Infrastructure and Heavy

__ Correctional Facilities__ Hotels__ Office Buildings__ Healthcare

__ Industrial__ Residential

  1. Indicate the range in which you are most competitive and capable of performing.

__ Under $100,000__ $200,001 - $500,000__ $1,000,001 - $2,000,000

__ $100,001 - $200,000__ $$500,001 - $1,000,000__ Over $2,000,000

  1. List which trade(s) your company specializes in:

__ Access Flooring__ Equipment__ Metal Wall Finish__ Skylights

__ Agitators & Mixers__ Equipment Screens__ Movable Partitions__ Special Doors

__ Aluminum Windows &__ Expansion Joint Assemblies__ Ornamental Railings__ Special Flooring

Storefront Systems__ Fans & Blowers__ Overhead Doors__ Special Rooms

__ Ash Handling__ Feeders__ Painting & Wall Cover__ Spray Fireproofing

__ Asphalt Paving__ Fencing & Gates__ Parking Equipment__ Stage Equipment

__ Awnings__ Filters__ Pavement Markings__ Steel Stairs

__ Bag Houses__ Finish Carpentry & Millwork__ Phone, Data & Cable__ Stone Tops

__ Bulk Material__ Fire Alarm__ Piers__ Structural Steel

__ Carpeting & Resilient Flooring__ Fire Extinguishers & Cabinets__ Pipe Fabrication__ Stucco & EIFS

__ Chain Link Partitions__ Fire Protection__ Pipe Installation__ Termite Control

__ Chutes__ Firestopping__ Plumbing__ Terrazzo

__ Concrete Formwork__ Flagpoles__ Pools & Spas__ Tile

__ Concrete Reinforcing__ Food Service Equipment__ Postal Specialties__ Toilet Accessories

__ Concrete Turnkey__ Garage Equipment__ Precast Concrete__ Toilet Compartments &

__ Conveyors & Belting__ Generators__ Precipitators Accessories

__ Cranes & Hoists__ Gymnasium Equipment__ Pre-Engineered Bldgs__ Traffic Coatings

__ Crushes & Pulverizes__ HVAC__ Projection Screens__ Turbines

__ Cubicle Curtains & Tracks__ Handling__ Ready Mix Supplier__ Wall & Corner Guards

__ Custom Cabinets__ Insulation__ Residential Appliances__ Walkways & Covers

__ Dampeners__ Lab/Classroom Casework &__ Roof Accessories__ Water Treatment

__ Demolition Equipment__ Roofing__ Waterproofing & Sealant

__ Detention Equipment__ Landscaping & Irrigation__ Rough Carpentry__ Window Treatment

__ Dock Equipment__ Laundry Equipment__ Seating__ Wire Shelving

__ Doors, Frames & Hardware__ Light Gage Framing Systems__ Security Systems__ Wood & Vinyl Windows

__ Dryers__ Lockers & Benches__ Separators__ Wood Flooring

__ Drywall & Acoustical Tile__ Louvers & Vents__ Signage__ Wood Framing

__ Dust Collectors__ Masonry__ Silencers__ Vacuum Packages

__ Earthwork__ Mechanical Turnkey__ Site Concrete__ Visual Display Boards

__ Electrical__ Medical/Dental Casework__ Site Retaining Walls__ Other______

__ Elevators__ Medical/Dental Equipment__ Site Utilities__ Other______

Section III: Insurance Information

  1. Who is your Insurance carrier? ______

Name of Contact: ______

Phone Number: (____)______

  1. Indicate the type of Insurance you have:

__ Commercial General Liability__ Workers Compensation and Employer’s Liability__ Professional Liability

__ Excess Liability__ Automobile Liability__ Pollution

Section IV: Safety Information201420132012

  1. Indicate EMR Rates: ______

Recordable Incident Rate: ______

  1. Indicate if you have any OSHA 30 Certified Employees? __ Yes __ No If yes, how many? ____
  2. Do you have a written Company Safety Policy and Program? __ Yes __ No If yes, will you provide it if requested? __Yes __ No
  3. Have you had any fatalities in the past five years? __ Yes __ No If yes, how many fatalities and please explain: ____

______

Section V: Financial Information

  1. Name of your Bank: ______

Name of Contact: ______Phone Number: (___)______

  1. Dun & Bradstreet Number: ______Dun & Bradstreet Rating: ______
  2. Do you utilize a bonding company? __ Yes __ No If yes, indicate bonding capacity: Per Job ______

Aggregate ______

Surety Company Name: ______

Address: ______

City: ______State: _____ Zip: ______Country: ______

Section VI: Legal Information

  1. Has your company or any of its principals ever petitioned for bankruptcy, failed in business, defaulted or been terminated on a contract awarded to you? __ Yes __ No If yes, please explain:______
  2. Have any of the owners, officers or major stockholders of your company even been indicted or convicted of any felony or other criminal conduct? __ Yes __ No If yes, please explain: ______
  3. Has your company ever been precluded from pursuing public work or ever been found to be a non-responsive by a public agency? __ Yes __ No If yes, please explain: ______

Section VII: References and Additional Information

  1. List three references from jobs you’ve previously worked on. These references may be contacted.

Project Name: ______Location: ______

Contact Name: ______Phone Number: (____)______

Project Name: ______Location: ______

Contact Name: ______Phone Number: (____)______

Project Name: ______Location: ______

Contact Name: ______Phone Number: (____)______

  1. Please list any additional information that you feel will help us determine your firm’s qualifications and expertise. If available, please attach an updated copy of your firm’s AIA A305 Document.

We have attempted to answer all questions in a full and complete manner to assure that our answers are not in any respect misleading either by expressing ourselves in a misleading or ambiguous manner or omitting information. We recognize that Jordon Construction (JCC) will be relying on the accuracy of the information and our responses in this questionnaire in deciding whether to permit us to bid and in awarding work to our Company.

Pre-Qualification Questionnaire was completed by:

Signature: ______Title: ______

Name: ______Date: ______

(Must be an Officer, Manager or Principal) REV4.2015