FB LinkedIn

Sub-Contractor Online Pre-qualification Form

Major Trade(s):
A)
B)
C)
D)
Company Information:
Company Name
Address
City
State
Zip Code
Telephone
Fax
Contact Person
Years in Business
Years in Business Under Present Name
Total Number of Employees:
Office:
Field:
Shop:
List Geographic Areas Covered:
List Trades and State(s) in Which Company Holds Licenses:
State 1
License Number 1
State 2
License Number 2
State 3
License Number 3
State 4
License Number 4
References
Bank References:
Bank Reference 1:
Contact 1:
Phone 1:
Bank Reference 2:
Contact 2:
Phone 2:
List Five Trade References (Contact & Phone):
Contact 1:
Phone 1:
Contact 2:
Phone 2:
Contact 3:
Phone 3:
Contact 4:
Phone 4:
Contact 5:
Phone 5:
List Five General Contractor References (Contact & Phone):
Contact 1:
Phone 1:
Contact 2:
Phone 2:
Contact 3:
Phone 3:
Contact 4:
Phone 4:
Contact 5:
Phone 5:
Projects
List Three Major Projects Presently Under Construction:
Project 1:
Project Name:
Owner:
Contact:
Phone:
Start Date:
Finish Date:
Contract Amount:
Project 2:
Project Name:
Owner:
Contact:
Phone:
Start Date:
Finish Date:
Contract Amount:
Project 3:
Project Name:
Owner:
Contact:
Phone:
Start Date:
Finish Date:
Contract Amount:
List Revenue for the Past Three Years:
2012:
Private Work:
Public Work:
2011:
Private Work:
Public Work:
2010:
Private Work:
Public Work:
Current Backlog of Uncompleted Work ($):
Safety
Have You Ever Failed to Complete a Project?
Yes      No  
If yes, explain:
Do You Have a Written Safety Program?
Yes      No  
Do You Require Your Field Employees to be OSHA 10 Hour Certified?
Yes      No  
Have You Been Cited by OSHA Within the Last Four Years?
Yes      No  
If yes, explain:
What are Your Standard Limits of Insurance Coverage?
General Liability
Limit:
Insurance Co:
Broker:
Phone:
Umbrella
Limit:
Insurance Co:
Broker:
Phone:
Workers Compensation
Limit:
Insurance Co:
Broker:
Phone:
Are You Bondable?
Yes      No  
Surety Co. ($):
Single Job Limit ($):
Aggregate ($):
Broker:
Phone:
Workers Compensation Modification Rating (EMR for Last Three Years)
2012:
2011:
2010:
Do you offer Health Insurance for your Employees?
Yes      No  
If yes:
Full Coverage      Partial Coverage      No Reimbursement 
Do You Have a Formal Employee Training Program? Yes      No  
What Means Do You Use for Employee Training (indicate all that apply)?
In House Training Programs
Yes      No  
Gould Institute (ABC)
Yes      No  
Trade School/Apprenticeship Program
Yes      No  
Continuing Education Programs
Yes      No  
Seminars and Workshops
Yes      No  
Do You Qualify as an Approved Disadvantaged Business Enterprise (DBE)? Yes      No  
(Please Attach a Copy of the Certification)
Do You Qualify as an Approved Minority Business Enterprise (MBE)? Yes      No  
(Please Attach a Copy of the Certification)
Does Your Company Have Any Particular Specialized Areas of Expertise?
Is Your Firm a Member of Any Trade/Business Associations?
Minimum Size of Job Your Firm Would Like to Perform ($):
Maximum Size of Job Your Firm Would Like to Perform ($):
Has your organization ever petitioned for bankruptcy, failed in business, defaulted or been terminated on a contract awarded to you? If so, please explain in detail:
Has your organization ever had a claim made against it for improper, delayed, defective or non-compliant or failure to meet warranty obligations? If so, please explain in detail:
Submitted By:
Title:

Our Mission

Ryan Gootee General Contractors is dedicated to bringing our clients construction services that are of the highest quality and value. We strive to promote lasting relationships by exceeding our clients' expectations and fostering an environment of teamwork and company growth.