Subcontractor Pre-Qualification

General Information

Company Name

Street Address

City/State

Zip Code

Contact Name

Email Address

LA License #:

Phone

Fax

Federal Tax ID

License to Perform Work (Trades)

M/W/DBE (Minority Business Enterprise) Certification
 Minority Woman Disadvantaged Veteran Small Business Other


Certifying Agency Names

Type of Business

 Corporation LLC Partnership Individually Owned Other

Date Incorpotated/Established


President/Manager/Owner

Insurance Coverage Type Limits

Workmen's Compensation

General Liability

Excess / Umbrella Liability

Automobile Liability


Type of Work Projects

 Multi-Family Medical Commercial Governmental Restaurants Education Civil Other


Average Contract $ - (Average amount for projects last 3 years)

Average Volume $ - (Annual volume average for the last 3 years)


Work in Progress

Job Name



Owner or GC Contact



Contract Amount $



Scheduled Completion Date





References

Trade References



Project References





Safety Experience Modifier

Year

EMOD


Plan Room

 FTP Sites iSqFt Site Dodge/McGrawHill