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Contractor/Vendor Qualification

Contractor/Vendor Qualification

GENERAL INFORMATION AND CORPORATE HISTORY

Organization name:

Prepared by (Name/Title):

Email Address:

Phone Number/Fax Number:

Address:

Type of work performed (work category/scope):

Percent of work normally performed by your own forces (not subcontracted):

How many years has your organization been in business as a contractor/supplier?

How many years has your organization been in business under its present name?

Under what other names has your organization operated?

Type of Organization: CorporationPartnershipIndividualDBEWBECertified DBE/WBEOther (type below)

If your organization is a corporation please list the following: Date of incorporation? State of Incorporation? Presidents name? Vice President Name? Secretary name? Treasurers name?

If your organization is a partnership, please list the following: Date of organization? Type of partnership? Name(s) of general partners?

If your organization is individually owned, please list the following: Date of organization? Name of owner?

List the trade categories in which your organization is legally qualified to do business and indicate registration or license number, if applicable: Trade category? Registration? License number?

Claims and suits? If yes, briefly explain below. YesNo

Are there any judgments, claims, arbitration or mediation proceedings, or suits pending or outstanding against your organization? If yes, briefly explain below. YesNo

Has your organization filed any lawsuits or requested arbitration or mediation with regard to construction contracts within the last 5 years? If yes, briefly explain below. YesNo

Has any officer or principal of your organization ever been an officer or principal of another organization when it declared or filed for bankruptcy? If yes, briefly explain below.

Attach a listing of construction projects your organization has completed in the past five years:

Bonding capacity

(Name of Surety, address, phone number & primary contact person):

Insurance Company (Name, address, phone number):

List your workers compensation experience modifier for the last three (3) years: EMR 2016? EMR 2017? EMR 2018?

Does your organization have a written OSHA compliant safety policy?