SUBCONTRACTOR/VENDOR PREQUALIFICATION FORM

Transcription

1 SUBCONTRACTOR/VENDOR PREQUALIFICATION FORM In order to develop a more complete knowledge of your company and coordinate with CJW s future opportunities, please complete this form and return to: CJW Construction, Inc. 841 E. Washington Avenue, Suite B Santa Ana, CA / Fax: hr@cjwconstruction.com COMPANY INFORMATION Legal Street Mailing Phone: Fax: Website: Please list any other offices you may have? Please select: Corporation Partnership Sole Proprietorship Subcontractor Supplier Contractor s Licenses: How many year s in business: Number of Employee(s): Principal Contact: Title: Phone: Fax: Estimating Contact: Title: Phone: Fax: Please include an Organizational Chart. Geographic areas of work: Please list state(s) in which you conduct business: Type and Size ($$) of Work you wish to perform: List all Divisions and Trades: Please use separate sheet. Do you have experience with LEED projects? Yes No

2 Are you willing to bid prevailing wage projects? Yes No Company s Minority Status: Check all that apply and provide proof of certifications: County, City, State and Transportation Departments: DBE Disabled Business Enterprise DVBE Disabled Veteran Business Enterprise MBE Minority Business Enterprise WBE Women Business Enterprise SBE Small Business Enterprise Federal Contracts (DoD)/Small Business Administration: HUBZone Historically Underutilized Business Zone LB Large Business (including non-profit) SDB Certified by SBA as a Small Disadvantaged Business SBA 8(a) Certified by SBA as a Small Business Administration 8(a) WOSB Woman Owned Small Business VOSB Veteran Owned Small Business SDVOSB Service Disabled Veteran Owned Small Business SB Small Business LOSB Locally Owned Small Business Other Minority Ownership: Black American Hispanic American Native American (includes American Indian, Eskimo, Aleut and Native Hawaiian) Asian/Indian American (includes India, Pakistan, Bangladesh) FINANCIAL INFORMATION Financial Statements may be requested. Federal Tax ID: Dunn & Bradstreet Number: Current Banking Information: Name of your bank: Phone/Fax: Current Bonding Information: Surety Company: Broker: Phone/Fax: Bonding Capacity: Per Job $: Per Aggregate $: Bond Rate:

3 Current Insurance Information: Can your company satisfy the insurance requirements set forth in Appendix??? Yes No If no, please explain EXPERIENCE & HISTORY 1. Have you worked with us previously? Yes No If yes, how many years has your company been performing work for us? 2. Do you subcontract any portion of the onsite work you perform? 2a. Do you pre-qualify your subcontractors? Yes No 3. Has there been any change in ownership of your company during the past three (3) years? (Note publicly traded companies do not have to answer) 4. Names of related companies: a. Parent Company: b. Subsidiaries: c. Affiliates: 5. Has your company changed names or contractor s license number(s) in the past 10 years? 5a. Which states have license(s)? 6. During the last 10 years has your company or any of the related companies identified in item 4 above been a debtor in a bankruptcy case? 7. Have you failed to complete any work awarded to you within the last five (5) years? 8. During the past five (5) years, has your company paid liquidated damages in connection with a project? 9. During the past five (5) years, has anyone brought legal proceedings (litigation, arbitration, etc.) against your company in connection with a construction project or for fraud, theft or other act of dishonesty? 10. During the past five (5) years, has any surety company made any payments on your company s behalf?

4 11. During the past five (5) years, has any insurance carrier, for any form of insurance, refused to renew or canceled any insurance policy covering your company? 12. Do you have your own equipment that you use? 13. Do you have any Certifications? 14. Do you have a Stamped Engineer on staff? Yes No If yes, how many? 15. What agencies have you worked with? Please use separate sheet if necessary. UNION AFFILIATIONS Union Non Union If union, please list who you are affiliated with. REFERENCES List three (3) major suppliers: List three (3) General Contractors you regularly do business with:

5 SAFETY 1. Does your company have a safety program? 2. What is your current experience modification rate for Workman s Compensation? 3. On a separate sheet, please list any OSHA citations against your company for the past five (5) years and the outcome of each citation. 4. Does your firm have a pre-hire drug testing program? ***CJW does not have a resale certificate, so please make sure all taxes are included on quotes. ***Bonding is required on Subcontract Agreements more than $25, ***Projects funded under the American Recovery and Reinvestment Act must meet Reporting Requirements. To view Reporting Requirements go to It is also listed under FARS