TRADE CONTRACTOR PREQUALIFICATION STATEMENT
Part I
Firm Name:
__________________________________________________
Address: __________________________________________________
City/State/Zip: __________________________________________________
Telephone & Fax Nos:
__________________________________________________
Scope of Work:
__________________________________________________
Federal ID No.:
__________________________________________________
Contractor License No.:
__________________________________________________
Worker's Comp. Policy No.: __________________________________________________
Name of Principal(s): ________________________________________________________
Name of Bid Contact: ________________________________________________________
E-MAIL ADDRESS:__________________________________________________________
Bank Reference: ________________________________________________________
________________________________________________________
Material Suppliers:
1)
________________________________________
____________________________________________________
2)
____________________________________________________
____________________________________________________
Customer References: 1) ____________________________________________________
2)
____________________________________________________
Part II Status of Company
What year did your company go into business?__________________________________
How many years experience have the Owner's had?______________________________
Has your company ever failed to complete work awarded them?_______________________
Has your company ever been placed in default?___________________________________
Has your company ever failed to satisfy a claim for unpaid material, equipment or Labor?___
Has your company ever filed for bankruptcy?_____________________________________
Are there legal action(s) pending against your company?___________________________
What geographic area(s) does your company work in?______________________________
What type of entity is your business (corporation, partnership, limited liability company,
proprietorship, etc.)? ________________________________________________________
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