In addition to completing our Subcontractor Qualification, you will need to submit the following documents:

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1 EXEMPLARY BUSINESS RELATIONSHIPS EXCEPTIONAL PERFORMANCE SUSTAINED EMPLOYEE OWNERSHIP Dear Sir/Madam, Exemplary business relationships and exceptional performance are not possible without highly qualified subcontractors and vendors. Branch s prequalification process ensures we are assembling a strong team to deliver the project, which in turn should give you the confidence that committing your firm to the project is a good use of your resources. We collect and maintain a current qualification from every subcontractor and vendor with which we do business. Any qualification older than one year will be considered expired and must be renewed for future project awards. In addition to completing our Subcontractor Qualification, you will need to submit the following documents: Insurance & Safety Certificate of Insurance stating the limits stated in the qualification statement OSHA 300A logs from the past three years Experience Modification Rating (EMR) letter from Worker s Compensation or NCCI worksheet for the past three years Financial & Bonding Financials We reserve the right to request financials at any time. Bonding Letter Specific to Roofing and Site Contractors. May be requested if needed for project. Current IRS W-9 Form (Request for Taxpayer Identification and Certification). Our qualification form is attached and may also be downloaded at: Please the completed forms to Kim Benton at kimb@branch-associates.com. Please contact Pam if you are unsure as to the status of your qualification on file. Your cooperation with our qualification process is appreciated and look forward to our continued partnership with your firm. 1 of 5 Revised 11/25/15

2 SUBCONTRACTOR QUALIFICATION Name & of person completing Qualification: Section 1 Company Information Firm Name: Website: Mailing Address: Shipping Address: Address for Headquarter/Main Office (if different than above): Telephone: Fax: Federal Employer Identification Number (FEIN): Contractor s License Number: Class: State: Expires: Explain any limits on your firm s license: Firm Type: Does your firm have union affiliations? Is your firm SWAM/ HUB S W Richmond MBD Section 2 Organization Name of President: Years in Position: Name of Key Personnel (1): Years in Position: Name of Key Personnel (2): Years in Position: Date the firm was organized in its present form: List any former names your organization has operated under: Is your company a subsidiary or affiliate of another firm? -parent company s name: Is the firm now, or has it ever been involved in bankruptcy or reorganization proceedings? Are there any pending or outstanding judgments, claims, or suits? Within the last five years, has your firm made payment of actual and/or liquidated damages for failure to complete a project by the contracted date? Has your firm ever been terminated on a contract for cause? Has your firm ever been found guilty on charges relating to conflicts of interest, convicted on criminal charges relating to contracting, construction, bidding, bid rigging or bribery? In the last ten years, has your organization or any officer of your organization ever been fined or adjudicated of having failed to abate a citation for building code violations by a court or local building code appeals board? 2 of 5 Revised 11/25/15

3 Section 3 Bonding Capacity Have any Performance or Payment Bond claims ever been paid by any surety on behalf of your organization? If yes, provide the date and amount of the claim(s): Can you obtain a bond? If yes, name of Bonding Company: Name of Bonding Agent: Telephone: Address: Bond Premium Rate: Largest Bond obtained in the last three (3) years: $ Maximum Bonding Capacity: $ Single Project Bonding Capacity: $ Section 4 Financial Bank Reference(s): Name of Contact: Telephone: Address: Annual revenue for last three (3) years: Year Revenue Current Number of Employees on Payroll (total): Office Employees Field Superintendents Field Craftsmen Total Remaining to Bill for Work under Contract (Backlog) $ Section 5 Experience/References In the past three years, please provide the following information for your three largest projects: Project Name/Location: Project Name/Location: 3 of 5 Revised 11/25/15

4 Project Name/Location: Section 6 Safety & Loss Prevention Have you received any OSHA violations classified as serious, willful or repeat violation in the past three years? If yes, please explain: Attach additional documentation if necessary. Does your company have a written safety program? Does your company have a written substance abuse policy that addresses pre-employment, post-accident, random and reasonable suspicion drug testing? Safety Performance: From your OSHA 300A logs for the most recent three years: Year: A. Total Number of Manhours B. Number of Injuries without Lost Workdays (Lines I+J) C. Number of Lost Workday Cases (Line H) D. Number of Fatalities (Line G) E. Total Number of OSHA 300 Recordables (Total of M) F. Total Recordable Case Incident Rate (TRCIR) G. Lost Workday Case Incident Rate (LWCIR Total Recordable Case Incident Rate should be calculated for each year using the following formula: (E Above) x 200,000 Employee Hours Worked (Given Year) Lost Workday Case Incident Rate should be calculated for each year using the following formula: (C Above) x 200,000 Employee Hours Worked (Given Year) Provide your Experience Modification Rating for the most recent three years: Experience Modification Rating Year: 4 of 5 Revised 11/25/15

5 Section 7 - Insurance Provide a copy of your Certification of Insurance stating the following limit requirements: General Liability, including Contractual Liability Automobile Liability, including Hired Auto and Non-Owned Auto - $1,000,000 Combines Single Limit $1,000,000 Each Occurrence $ 100,000 Fire Damage Umbrella Policy - $3,000,000 Each Occurrence $1,000,000 Personal and Adv Injury $2,000,000 General Aggregate Professional Liability Insurance if applicable $2,000,000 Products/Completed Operations Aggregate $1,000,000 Each Occurrence $1,000,000 Aggregate Stop Gap Mandolitis Coverage (for all work in West Virginia only) Worker s Compensation & Employers Liability Insurance that complies with the state statutes in which the work will be performed $1,000,000 Each Accident $1,000,000 Each Occurrence by Disease $1,000,000 by Disease-Policy Limit Section 8 Bid Notice Information Contact name and title: Phone: address: Signature - Confidentiality Agreement Branch agrees to hold and keep the information provided by Subcontractor in this Qualification confidential unless otherwise required to be disclosed by any law, statute, regulation or legal process. Any external discussions regarding Subcontractor will be limited to Subcontractor s performance on project references provided or other projects which Branch may become aware Subcontractor is or was involved. Organizational and financial information provided will not be discussed with outside parties. Have you read and agree to our Standard Terms & Conditions of the Contract? By signing this statement, I,, duly authorized as (Name) (Title) of, affirm and certify that the information (Company) contained herein is accurate, and also entitle Branch & Associates, Inc. to contact references and names contained in this questionnaire. Date Signature 5 of 5 Revised 11/25/15