Subcontractor Qualification Form
RETURN TO:
W.E. DENTMON CONSTRUCTION, INC.
Project:
___________________________________________________________________
Date__________________
Company Name_____________________________________________________________
Mailing Address_____________________________________________________________
Physical Address____________________________________________________________
Phone_____________________Fax_____________________E-mail___________________
Contact Name_______________________________________________________________
Geographic Area of Business Interest_____________________________________________
Years in Business Under Present Name___________________________________________
Work Specialty______________________________________________________________
Years Performing Work Specialty_______________________________________________
Work Now Under Contract $______________________
Work in Place Last Year $________________________
Value of Work Presently Bonded $__________________
Total Bonding Capacity $_________________________
Bonding Surety $________________________________
Bonding Agent________________________________________________________________
Phone Number__________________________________________________________
Insurance Agent_______________________________________________________________
Phone Number__________________________________________________________
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Policy Number |
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Expiration Date |
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General Liability Insurance |
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* Workers Compensation Insurance |
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* Exemptions not
acceptable
Percent of Work Performed by Own Forces _________%
Total Number of Permanent Staff Employed by Company___________
This includes _________Office Staff _________Field Personnel
Average Work Force for the Past Five Years__________________
Is Company in Compliance with EEO Requirements? ____Yes ____No
Approximate Value of Equipment Owned by Company $_______________________
Has Company Ever ________________ Failed to Complete a Contract?
________________ Been Involved in Bankruptcy or Reorganization?
________________ Had Pending Judgment Claims or Suits?
_________________ Been Assessed Liquidated Damages on any Project?
Does Company Have a Current Rating with Dun & Bradstreet? ______Yes ______No
If Yes, what is your D&B RATING?
Trade References (Contact Name, Phone, Address)
1. ______________________________________________________________________________
2. ______________________________________________________________________________
3. ______________________________________________________________________________
General Contractors with whom your Company has worked within the past two years (Contact Name, phone, Address)
1. _______________________________________________________________________________
2. _______________________________________________________________________________
3. _______________________________________________________________________________
List Four of your Most Significant Projects Currently Under Construction:
Name & Location Contact
Name/Phone Contract
Amount Architect Completion
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Signature_____________________________________________________________________
(Officer of the company)
Name_____________________________________Date_______________________________
Witness______________________________________________________________________
Name_____________________________________Date_______________________________
Type of Company: ________Corporation ________Partnership ________Sole Proprietor