Subcontractor Prequalification

Subcontractor Prequalification Form

COMPANY INFORMATION

What is your legal business name?

Are you DBA (doing business as) another name?

Yes No

If yes, what name?

How many years have you been in business as a subcontractor?

Less than 1 year

1 - 5 years

5 - 10 years

Over 10 years

Company's principal office address:

City

State

Zip Code

Primary Contact

First Name

Last Name

Phone

TAX/LICENSE INFORMATION

What is your Federal Employer Identification Number (FEIN)? Click here for more information about FEIN

E-Verify Company Identification Number Click here for more information about E-Verify

States in which you are registered to do business with the applicable Secretary of State (or similar governmental body)

OWNERSHIP / MANAGEMENT

Names of company's officers and executives. If an LLC, include all members and any managers or managing members. If a partnership, include all partners.

Officer

Partner

Names of individuals or entities owning more than 5% of the company

Total Number of employees

Certifications

List any of the following certifications along with the certification number(s) and expiration date(s):
AABE, FBE, HABE, AP/ABE, 8A, HUBZone, Native American 8A, NWBOC, SBE, SDVOSB, VOSB, WOSB, DBE, MBE, or any other certification.

CLAIMS / SAFETY

Experience Modification Rate (EMR) - Current and last 3 years' EMR

Click here for more information on your EMR or ask your insurance agent for assistance.

Current Year

Last Year

Two Years Ago

Three Years Ago

Last 3 years' OSHA Total Recordable Frequency Rate

Click here for more information on how to calculate your Rate.

Last Year

Two Years Ago

Three Years Ago

Have you had any OSHA violations in the last 5 years?

Yes No

Violation Date and Description

Does your Company have a written safety policy/program?

Yes No

Does your Company have a safety manager/director?

Yes No

Safety Manager / Director

Name

Phone

List any judgments, claims, arbitration proceedings, administrative or agency appeals, board proceedings, or suits threatened, pending or outstanding or in which the company (or any parent, subsidiary, affiliate, or officer) was a named party in the last 5 years (whether initiated by you or another party).

Description

Has the company ever failed for any reason to complete, in whole or in any part, any work awarded to it?

Yes No

If so, please explain

WORK EXPERIENCE

Typical trades performed (select typical trades performed) *

Percentage of work that is self-performed

Union affiliation, if any

List each category of work, if any, that the company typically self-performs.

Average size of contracts

List your three largest projects completed.

Name

Year Complete

Subcontract Value

Name

Year Complete

Subcontract Value

Name

Year Complete

Subcontract Value

Total dollar value of all work currently under contract

Total dollar value of all work currently in progress

Total dollar value of all work completed within the past year

REFERENCES

General Contractor

Include 3 general contractor references, including the company name, telephone number, and person having the most knowledge of your dealings with their organization over the last 5 years.

Company Name

Phone

Contact Name

Company Name

Phone

Contact Name

Company Name

Phone

Contact Name

Trade Contractor

List 2 trade contractor references, including company name, phone, and person having the most knowledge of your dealings with their organization over the last 5 years.

Company Name

Phone

Contact Name

Company Name

Phone

Contact Name

INSURANCE/BONDS

Insurance Broker/Agency

Contact Person

Phone

Bonding Agency Name

Contact Person

Phone Number

Contact should have knowledge of your company's bonding capacity, performance, and financials history.

Check here if you do not have bonding capacity established with a Surety.

Surety Company Name

List the dollar amounts of the company's bonding capacity. (Numbers only - do not include commas, dollar signs, etc.)

Per Project

Aggregate

Has any current or former surety increased, decreased, or placed any limits on the company's bonding capacity or otherwise declined to issue a requested bond?

Yes No

If yes, explain.

FINANCIAL REVIEW:

In order for us to complete our prequalification of your firm, please provide your most recent fiscal year-end financials including a balance sheet and income statement or profit and loss statement. If available, audited financials are preferred. Click here to see a sample balance sheet and income statement. Please send your financials to financials@newsouthconstruction.com

(If an NDA is required, please contact financials@newsouthconstruction.com)

By submitting this form, the submitting Company (and related entities) hereby certifies and swears that the information contained herein and attached hereto, and all documents and other information provided as requested herein, is true, complete, and correct on and as of the date hereof. If such information is not true, complete, and correct, in addition to all other remedies available to it, New South Construction Company or any joint venture or other New South entity may terminate any contract, purchase order, purchase agreement, or other agreement with the undersigned and such termination shall be considered a for cause termination. Any misrepresentations provided shall be considered fraudulent inducement in and to any subsequently executed subcontract.