GENERAL COMPANY INFORMATION Legal Company Name * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Company Website http:// President/CEO * Scope of Work * States Served * Company point of Contact * Estimating Point of Contact * Company Tax Identification Number * COMPANY FINANCIAL INFORMATION Name of Financial Institution * Financial Institution address for Company * Address 1 Address 2 City State/Province Zip/Postal Code Country Financial Institution Contact Phone * (###) ### #### Can the Company secure a bond? * Yes No Does the Company have a history of Bankruptcy? * Yes No SAFETY INFORMATION Current Experience Modifier Rating(EMR) Do you have a written Safety Policy? * Yes No Has the Company had any OSHA citations in the last 3 years? * Yes No Do you have a written substance abuse policy? * Yes No LEGAL INFORMATION Does the Company participate in E-verify? * Yes No To your knowledge, does the Company have any employees that have been convicted of a felony? If so please, explain. * Has the Company been engaged in any legal actions in the last 10 years? If so, please explain * Is the Company involved in any active liens? * Yes No CONTRACT PERFORMANCE Average Contract Value: * Largest Contract completed to date: * Has the Company ever failed to complete a project for any reason? * PROJECT PORTFOLIO List your 3 largest completed projects including Owner, location, contract amount, and project description: * REFERENCES Reference #1 * Reference type, Contact name, phone, and Company: Reference #2 * Reference type, Contact name, phone, and Company: Reference #3 Reference type, Contact name, phone, and Company: Upload W-9 * FileField;Maxsize=100KB;Multiple Upload COI * FileField;MaxSize=100KB;multiple Thank you!
