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Company Name:
Street Address:
City, State, Zip:
Phone #: Fax #:
Contact Person
E-mail:
Principal(s) Name:
Contractor License #: UBI#:
In Business Since:  

Nature of Firm's Work:

Project types in which you are interested:
 High End Residential  High-Tech
 Commercial  Industrial
 Forensic Repair  Tenant Improvements
Preferred Project Size:

Successful Projects in the last three years:
#1
Project Name/Location:
Contract Amount:  
General Contractor Name:
Contact Name: Phone #:
#2
Project Name/Location:
Contract Amount:  
General Contractor Name:
Contact Name: Phone #:
#3
Project Name/Location:
Contract Amount:  
General Contractor Name:
Contact Name: Phone #:

Safety Statistics: Number of lost time accidents last three years:
Experience Mod. Factor: 2005:  2004:  2003: 

List three repeat clients:
#1
Company Name:
Contact Name: Phone #:
#2    
Company Name:
Contact Name: Phone #:
#3    
Company Name:
Contact Name: Phone #:

Are you bondable? Yes   No  
Bonding Agent:
Bonding Contact: Phone #:
Bonding Capability:

Bank:
Contact Person: Phone #:

# of Employees: Office: Field:
Annual Volume: Last year: Prior Year:

Labor Status: Union   Merit

Is your company a certified minority or woman-owned business? Yes No
If yes, what kind? MBE  WBE  DBE  Other:

Have you had any disputes within the last three years with a client/owner/contractor
in which either arbitration or litigation was initiated?

Yes   No
If yes, please explain:
 
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