Subcontractor Prequalification Form

Please Check One
Corporation	Partnership	Sole Proprietor

General Information
Company Name:		Contact Number:
Address:
Company Phone:		Fax:
Year Business Started:		How Long under Ownership?:
List Divisions of Work you Perform

Who Should We Direct Bid Requests To?
Primary Contact:		Phone:
E-mail:		Fax:

Principals & Officers of your Company
Name:		Title:
Name:		Ttle:

Licenses
Contractor's Lic #:		Tax ID #:
Employmnet Sec #:		UBI #:
L&I Acct #:

Banking / Bonding / Insurance
Bank & Branch:		Bank Phone:
Bank Address:		Bank Fax:
Bonding Company (License):		Bonding Company (Performance):
Agent:		Agent Phone:
		Agent Fax:

Insurance Agent:		Agent Phone:
		Agent Fax:

Union Affiliation & Local Chapter No.
Name:		Chapter:
Phone:

Construction Association Affiliations
Name:		How Long?:
Name:		How Long?:
Name:		How Long?:

Suppliers (Please List your 3 largest suppliers)
Name:		Phone:
Name:		Phone:
Name:		Phone:

References (must be current & include at least 2 general contractors)
Name:		Phone:
Name:		Phone:
Name:		Phone:
Name:		Phone:

Are you currently involved in a claim dispute with any of your general contractors?
YES	NO

(if yes, please explain below)


Are you currently involved in any lawsuits?
YES	NO

(if yes, please explain below)


Do you have a written safety program?
YES	NO

(if yes, please explain below)


*I certify the above information is true and correct and authorize yout to contact the above references regarding our credit standing or past performance.*
YES	NO
Name:		Title: