Please complete the following to the best of your ability. We realize that the information requested may not apply to every subcontractor. If you are a supplier, rather than listing previous experiences on past projects, please provide recent data on projects for which you have supplied material.

COMPANY INFORMATION

Company Name:

Specialty:

Fax:

Title:

Pager:

Email:

Cellular Phone:

Telephone:

Address:

Contact Person:

Website address:

SIC Code(s)/NAICS:

Business Status: (Please check all that apply.)

Number of Employees:

Number of Years in Business:

Annual Volume: $

Please indicate if your firm is registered with any of the following Small Business Administration (SBA) programs:

- 8(a) Certification #

Name of Surety:

Is your firm bondable?

Does your firm have a Substance Abuse Program?

Does your firm have a Safety Program?

What is your current EMR (Experience Modification Rating)?

(Multiplier used in workers' compensation premium calculations to recognize accident experience)

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Bonding Limit: $

Subcontractor Qualification Form

- Sample Insurance Certificate

- Sample Insurance Requirements

 

SUBCONTRACTOR PREQUALIFICATIONS

When selected as one of Marsh Development's subcontractors, please have the following information available.
• Copy of W-9
• List of company license numbers
• List of state sales tax numbers
• List of state unemployment insurance numbers
• List of insurance agreements
• List of current projects
• List of recently completed projects
• Current financial statement

State:

City:

Zip: