SUB-CONTRACTOR REGISTRATION

Is the company a Minority Business Enterprise (MBE), Women Business Enterprise (WBE), Small Business Enterprise (SBE) or any other type of certified business enterprise?

If yes, what type?

Does the company have a line of credit from any lending institution? *

If yes, please provide details:

Lender's name, Address, Officer's name, Phone: *

Do you have the ability to bond projects? *

If yes, date of last bonded project:

Single project limit

Aggregate Limit

Bonding Company Name, Address:

In the past 5 years, has your company or any of its key personnel been investigated for or found to have committed a serious OSHA violation?
*

If yes, provide details:

What is your current Workman's Compensation EMR rate?
Please attach a copy of current EMR at end of form

Do you have written employee safety policy & program? *

Are there any open or aggregate liability claims that would impair your ability to insure a project? *

Has your company or any of its personnel been a party to a bankruptcy or reorganization proceeding? *

If yes, give date:

During the past 5 years, have any liens been filed against you by any of your sub-contractors or suppliers? *

If yes, give details:

Have you ever failed to complete a contract, been defaulted, or had a contract terminated? *

If yes, give dates and details: *

In the past 5 years, has your company or any of its key personnel been involved in any lawsuits arising from construction projects? *

If yes, give details:

Current projects Include name of project, scope of work, contract amount and completion date *

Trade References Include name of project, scope of work, contract amount and completion date *

Client References List 3 clients, include names and phone numbers *

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