Partner with Experts Committed to Quality

1Company Info

2Business & Licensing

3Scope of Work

4References

5Safety

6Insurance Uploads

7Bonding

8Certification / Exhibits

1. Company Information

Completion of this form is required for all vendors and subcontractors prior to bidding, contract execution, or commencement of work.

Legal Company Name(Required)

DBA (if applicable)

Business Address(Required)

Street Address Address Line 2 City State ZIP Code

Mailing Address (if different)

Street Address Address Line 2 City State ZIP Code

Primary Contact Name(Required)

Primary Contact Title

Primary Contact Phone(Required)

Primary Contact Email(Required)

Accounts Payable Contact

AP Email

AP Phone

2. Business & Licensing Information

Federal Tax ID / EIN(Required)

Attach W-9(Required)

Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 256 MB.

Business Structure(Required)

Corporation

LLC

Partnership

Sole Proprietor

State(s) Licensed In

License Type & Number(s)

License Expiration Date(s)

Attach Copies of Applicable Licenses

Drop files here or

Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 256 MB, Max. files: 10.

3. Scope of Work

Primary Trade / Services Provided(Required)

Concrete

Framing

Electrical

Plumbing

Mechanical

Roofing

Drywall

Flooring

Finishes

Site / Civil

Design / Engineering

Other

Other Trade / Service

Percentage of Work Self-Performed

4. Experience & References

Years in Business(Required)

Brief Description of Commercial Experience(Required)

Reference 1 - Company(Required)

Reference 1 - Contact(Required)

Reference 1 - Phone(Required)

Reference 1 - Email

Reference 2 - Company(Required)

Reference 2 - Contact(Required)

Reference 2 - Phone(Required)

Reference 2 - Email

Reference 3 - Company(Required)

Reference 3 - Contact(Required)

Reference 3 - Phone(Required)

Reference 3 - Email

5. Safety & Compliance

EMR (Experience Modification Rate)(Required)

OSHA Citations in Last 3 Years(Required)

Yes

If yes, explain OSHA citations

Safety Program

Written Safety Program

Toolbox Talks

Jobsite Safety Meetings

Attach Written Safety Program

Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 256 MB.

6. Insurance Requirements

All insurance policies shall remain in full force and effect throughout the duration of the Contract. Trade Partner shall not commence work until all required Certificates of Insurance and endorsements have been submitted to and approved by Contractor.

Minimum coverage includes: Workers’ Compensation, Commercial Automobile Liability, Commercial General Liability, Excess/Umbrella Liability, Professional Liability if applicable, Pollution Legal Liability where applicable, required endorsements, waiver of subrogation, additional insured status, primary and non-contributory wording, per-project aggregate, and complete forms schedule.

Certificates and endorsements are required prior to site access. Insurers must be rated A-VII or better by AM Best. Deductibles/SIRs are Subcontractor’s responsibility.

Attach Certificate of Insurance (COI)(Required)

Drop files here or

Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 256 MB, Max. files: 5.

Attach Insurance Endorsements(Required)

Drop files here or

Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 256 MB, Max. files: 10.

Attach Complete Forms Schedule(Required)

Drop files here or

Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 256 MB, Max. files: 10.

7. Bonding Information

Surety Company(Required)

Bond Rate

Single Job Capacity

Aggregate Capacity

8. Certification & Acknowledgment

The undersigned certifies that all information provided is true and complete and acknowledges that compliance with all licensing, safety, insurance, and contractual requirements is mandatory.

Authorized Representative Name(Required)

Authorized Representative Title(Required)

Authorized Representative Signature / Typed Name(Required)

Certification Date(Required)

Exhibit A - Subcontractor Leased Employee Agreement and Certification

Do you use an employee leasing company for workers’ compensation coverage?

Yes

Employee Leasing Company

Workers’ Compensation Carrier

A.M. Best Rating of Carrier

Inception Date of Leasing Contract

Subcontractor Name

Owner/Officer Signature / Typed Name

Owner/Officer Print Name

Owner/Officer Title

Leased Employee Agreement Date

Exhibit B - Workers’ Compensation Exemption Release

Do you have a Workers’ Compensation exemption?

Yes

Exempt Individual Name

Contractor Name

Exemption Expiration Date

Exempt Employee Signature / Typed Name

Exempt Employee Print Name

Subcontractor Name for Exemption

Owner/Officer Signature for Exemption / Typed Name

Owner/Officer Print Name for Exemption

Owner/Officer Title for Exemption

Exemption Release Date

Trade Partner Prequalification & Setup Form

1. Company Information

2. Business & Licensing Information

3. Scope of Work

4. Experience & References

5. Safety & Compliance

6. Insurance Requirements

7. Bonding Information

8. Certification & Acknowledgment

Exhibit A - Subcontractor Leased Employee Agreement and Certification

Exhibit B - Workers’ Compensation Exemption Release

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