Sub Contractor Qualification I. SUB-CONTRACTOR GENERAL INFORMATIONCompany Name* PhoneFaxPrimary Contact Email* Cell PhoneAddress SateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZIP City Type of OrganizationCorp.LLCPartnershipSole ProprietorYear EstablishedTrades Performed Current Number of EmployeesOfficeFieldSuperintendentsDIR NumberII. License InformationLicense NumberStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificLicense Classification/Type Federal Tax IDCurrent Classifications MBE WBE DBE Prevailing Wage Projects Yes No Affiliations Union Non-Union III. INSURANCE INFORMATIONInsurance Company PhoneFaxAgent Name PhoneEmail Address City SateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZIP Policy NumberYears with Insurance CompanyWorkers Compensation Carrier Policy NumberWorkers Compensation Current EMR/ERP Rate Claims paid in last 3 years Does your company meet or exceed E.H. Butland Corp. insurance requirements Yes No Download requirementsIV. SAFETY INFORMATIONSubstance Abuse Policy & Implemented Drug Screening Yes No Injury & Illness Prevention Program Yes No Conduct Safety Meetings Yes No If so how often? 201520162017V. BONDING INFORMATION/FINANCIAL CAPABILITYCan you provide bonding? Yes No Surety/Bonding Company PhoneFaxAgent Name PhoneEmail Address City SateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZIP Bonding Rate Bonding Capacity – Single Project Bonding Capacity – Aggregate How much of your work is currently Bonded PercentageProvide Name of Your Financial Institution Contact PhoneLine of Credit AmountUCC Filing Yes No VI. LEGAL IMFORMATIONHave any OSHA inspections resulted in violations over the last 5 years? Yes No Has a claim ever been filed against your Contractors State Bond? Yes No Has a claim ever been filed against your performance or material bond? Yes No Has your company ever had liquidated damages assessed for delays? Yes No Has your company or its principles or partners ever filed for bankruptcy? Yes No Has a contract issued to your company ever been canceled or terminated for non-performance? Yes No Have any of the company’s owners, principles or partners been indicted or convicted of any felony, fraudulent or other criminal activity? Yes No Has any insurance carrier, for any reason, refused to renew a policy for your company? Yes No Is your company or any of its Owners, Officers or major stockholders currently involved In any arbitration or litigation. Yes No Has any claim been filed in court or arbitration against your organization concerning your performance on a construction project. Yes No Has any claim been filed in court or arbitration against your organization for construction defects? Yes No Has any claim been filed in court or arbitration by your organization against a Contractor? Yes No VII. BIDDING INFORMATIONPrimary Contact Email CellPhonePreferred Project SizeUnder $50K50K – 100K100K – 200K200K – 500K500K – 1M1M – 2MProject Types (Select All That Apply) Medical/Healthcare Hospital/OSHPD Commercial Industrial Office Bldgs. MOB’s Surgery Centers Dialysis Centers Imaging Centers TI’s Diagnostic Imaging Oncology Treatment Parking Structures Schools Industrial Design/Build Assist PERFORMANCE EVALUATIONList five (5) major projects completed within the last 3 years. Include project name, location, your contract amount, contact name and cell phone.Provide three (3) references for other General Contractors you have completed work for within the last 3 years. Include Company name, contact, cell phone and email address.Provide three (3) separate material supply warehouses you regularly purchase materials from. Include supplier name, contact, cell phone and email address.