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: