become a subcontractor

Prequalification

Subcontractor Prequalification Form

Company Information
Company Name:
Address:
Phone Number: Fax Number:
Contact Name: Email Address:
Federal Tax ID #:
Type of Company


Date Formed:
No. of Employees:
Salaried:
Hourly:
Sales volume past three years:
Work under contract: Uncompleted backlog:
Average project size in place last year: Largest project completed:
Size of projects preferred: Project location preferred:
Does the company have offices, plants, or warehouses at other locations?
If yes, list addresses.
Trades of Work
List the type(s) of work normally self-performed by your company.
Labor
Does the company have any union labor agreements?
If yes, please list.
License
License Number
State
Type of License or Work Licensed for
License Number
State
Type of License or Work Licensed for
License Number
State
Type of License or Work Licensed for
License Number
State
Type of License or Work Licensed for
License Number
State
Type of License or Work Licensed for
MBE/WBE/SBE/DBE/DVBE Certification
Is the company certified?



Certifying Agency(s):
Bonding Capacity
Are you able to bond projects?
Bonding rate:
Single project limit: Aggregate limit:
Bonding Company Name & Address:
Agent Name & Phone Number:
Safety
ExperienceModifier
Rating (EMR) past 3 years:
2017  2016  2015 
Provide a letter from your insurance carrier/agent that certifies your past 3 years EMR rates.
Recordable Incident
Rating (RIR) past 3 years:
2017 2016 2015
A copy of each OSHA 300A log from the last 3 years must be uploaded to this questionnaire.
 
 
Does the company have a written safety program and/or policies?
Does the company have a written drug policy?
Are your employees MSHA certified?
Are you subject to any OSHA or MSHA restrictions or operating under any settlement agreements?
If yes, please explain and upload a copy of the agreement.
Insurance
Please upload a current certificate of insurance that complies with Robinson's sample certificate of insurance.
Bank Reference
Does the company have a line of credit from any lending institution?
Amt. of Credit Outstanding Balance Lender's Name/Address Lending Officer's Name/Phone No.
Amt. of Credit Outstanding Balance Lender's Name/Address Lending Officer's Name/Phone No.
Amt. of Credit Outstanding Balance Lender's Name/Address Lending Officer's Name/Phone No.
Completed Projects
List four (4) representative projects completed in the past five (5) years OR upload file.
Name of Project Contracting Company Contact Name/ Phone No. Contract Amount Completion Date
Name of Project Contracting Company Contact Name/ Phone No. Contract Amount Completion Date
Name of Project Contracting Company Contact Name/ Phone No. Contract Amount Completion Date
Name of Project Contracting Company Contact Name/ Phone No. Contract Amount Completion Date
       
 Upload completed projects list:  
     
Current Projects
List four (4) representative projects currently under construction OR upload file.
Name of Project Contracting Company Contact Name/ Phone No. Contract Amount % Complete
Name of Project Contracting Company Contact Name/ Phone No. Contract Amount % Complete
Name of Project Contracting Company Contact Name/ Phone No. Contract Amount % Complete
Name of Project Contracting Company Contact Name/ Phone No. Contract Amount % Complete
         
 Upload current projects list:  
     

Other Information
In the past five (5) years, has the company...
  1. operated under any other name?

  1. had any liens field against it by any of its subcontractors of suppliers?

  1. ever failed to complete a contract, been defaulted, or had a contract terminated?

  1. had liquidated damages assessed against it upon completion of a project?

  1. or any of its key people been a party to a bankruptcy or reorganization proceedings?

  1. or any of its key people been involved in any lawsuit arising from a project?

  1. or any of its key people been investigated for or found to have committed a violation of any labor laws?

  1. or any of its key people been investigated for or found to have committed a serious OSHA violation (you can research this here)?

  1. or any of its key people been investigated for or found to have committed a violation of state, federal, or local laws?

If you answered yes to any of the above questions, please provide details.
 
Name of person completing prequalification:
Title:
Email Address:
   
Name of person requesting certificate of insurance:  
Email Address:  

Acknowledgments
Please check below to acknowledge that you have read and understand the following programs & policies (all can be found in the Programs & Requirements section of our website, which is password protected. Please email the purchasing manager at purchasing@rcco.com for access):