SUBCONTRACTOR PRE-QUALIFICATION FORMSUBCONTRACTOR PRE-QUALIFICATION FORMStep 1 of 714% SUBCONTRACTOR PRE-QUALIFICATION FORMAPPLICATION DATE* MM slash DD slash YYYY DIR CERTIFIED:* YES NOBackgroundCOMPANY NAME:*TYPE OF COMPANY:*STREET ADDRESS*CITY:*STATE:*ZIP:*PHONE:*FAX:*EMAIL:* PRINCIPAL CONTACT:*PHONE:*CONTRACTORS LICENSE NUMBER:*CLASSIFICATIONS:*FEDERAL ID:*YEARS ESTABLISHED:* MM slash DD slash YYYY LEGAL STRUCTURE:** UNION NON-UNIONCHECK ALL THAT APPLY:* DVBE MBE SBE WBE PREVAILING WAGEsafetyWorkers Compliance Experience Mod Rate (EMR) and OSHA Incident Rate for the previous three (3) years:YEAR:* MM slash DD slash YYYY EMR:*INCIDENT RATE:*YEAR:* MM slash DD slash YYYY EMR:*INCIDENT RATE:*YEAR:* MM slash DD slash YYYY EMR:*INCIDENT RATE:*Please check all that apply to your companies Safety Compliance:Has a written OSHA Compliant Safety Program:* YES NOOperate regularly held jobsite safety meetings:* YES NOImplements a Drug Screening Policy for all employees:* YES NODo you have a full-time Safety Officer:* YES NOIf Yes, please provide contact information:NAME:*PHONE:*EMAIL:* SUBCONTRACTOR PRE-QUALIFICATION FORMSCHEDULE & PROJECTSWhat is the extent of your California Service Area:* SOUTHERN CA CENTRAL CA NORTHERN CA RIVERSIDE COUNTY COACHELLA VALLEY PALM SPRINGSProvide a summary of the three (3) largest projects currently under construction:1. PROJECT NAME:*GENERAL CONTRACTOR:*LOCATION:*START DATE:* MM slash DD slash YYYY CONTRACT AMOUNT:*2. PROJECT NAME:*GENERAL CONTRACTOR:*LOCATION:*START DATE:* MM slash DD slash YYYY CONTRACT AMOUNT:*3. PROJECT NAME:*GENERAL CONTRACTOR:*LOCATION:*START DATE:* MM slash DD slash YYYY CONTRACT AMOUNT:*Provide a summary of three (3) current projects in consideration for award: 1. PROJECT NAME:*GENERAL CONTRACTOR:*LOCATION:*START DATE:* MM slash DD slash YYYY CONTRACT AMOUNT:*2. PROJECT NAME:*GENERAL CONTRACTOR:*LOCATION:*START DATE:* MM slash DD slash YYYY CONTRACT AMOUNT:*3. PROJECT NAME:*GENERAL CONTRACTOR:*LOCATION:*START DATE:* MM slash DD slash YYYY CONTRACT AMOUNT:*PROJECT EXPERIENCE:* BIOTECH HOSPITALITY RELIGIOUS FACILITIES COMMERCIAL OFFICE INDUSTRIAL/MFG RESIDENTIAL DATA CENTER SCHOOL/UNIVERSITY RETAIL FEDERAL LEED SENIOR LIVING HOSPITAL/OSHPD MEP DESIGN-BUILD OTHER: SUBCONTRACTOR PRE-QUALIFICATION FORMINSURANCE & BONDINGHeading icon and descriptionBROKER:*LOCATION:*AGENT:*PHONE*Does your company provide additional insurance beyond General Liability and Workers Comp?Excess Liability:* YES NOPollution Liability:* YES NOAutomobile Liability:* YES NOPLEASE ATTACH LETTER OF INSURANCE ON COMPANY LETTERHEAD WITH INCLUDED LIMITS Can you provide payment and performance bonds?* YES NOBOND RATE:*CAPACITY:*AGGREGATE*SINGLE PROJECT:*BONDING AGENCY:*CONTACT:*PHONE:*Have you ever defaulted or had a project terminated within the past 5 years?* YES NOPlease explain*Are there any pending legal judgements against your company?* YES NOPlease explain*Has your company litigated against an owner, designer, or GC?* YES NOPlease explain* SUBCONTRACTOR PRE-QUALIFICATION FORMPERSONNELOWNER NAME*TITLE:*OWNER NAME*TITLE:*OWNER NAME*TITLE:*Current number of employees:ADMINISTRATION:*FIELD/CRAFTSMAN:*Primary contact person to obtain bids:NAME*PHONE:*EMAIL:* TITLE:*Has your company operated under a previous name:* YES NOFINANCIAL HISTORYPlease provide the following financial history for the past three (3) fiscal years: 1. Year:* MM slash DD slash YYYY Gross Revenue ($):*Gross Margin (%):*Net Profit/Loss ($):*Projects Completed (#):*Largest Single Project ($):*2. Year:* MM slash DD slash YYYY Gross Revenue ($):*Gross Margin (%):*Net Profit/Loss ($):*Projects Completed (#):*Largest Single Project ($):*3. Year:* MM slash DD slash YYYY Gross Revenue ($):*Gross Margin (%):*Net Profit/Loss ($):*Projects Completed (#):*Largest Single Project ($):*What is your current backlog ($):*As of December 31st of Last Year ($):* REFERENCESProvide three (3) Client References: 1. COMPANY NAME:*PHONE:*CONTACT:*TITLE:*2. COMPANY NAME:*PHONE:*CONTACT:*TITLE:*3. COMPANY NAME:*PHONE:*CONTACT:*TITLE:*I hereby certify, to the best of my knowledge, that all information submitted herein, including any attachments is true and correct as to not be misleadingPRINT NAME:*TITLE:*SIGNATURE:*DATE* MM slash DD slash YYYY Capital Building Services, Inc. will utilize this form as a pre-qualifying document for subcontractors and is should not be construed to constitute a commitment or a guarantee to perform specific services.INTERNAL USE ONLY OFFICE REVIEW:SAFTEY:*CONTACT:*DATE:* MM slash DD slash YYYY INITIALS:*SAFTEY:*CONTACT:*DATE:* MM slash DD slash YYYY INITIALS:*SAFTEY:*CONTACT:*DATE:* MM slash DD slash YYYY INITIALS:*ESTIMATING MANAGER:*FINAL APPROVAL:*
