Trade Contractors

"*" indicates required fields

PREQUALIFICATION STATEMENT

GENERAL INFORMATION:

Company Name:*

Federal Tax ID No:*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone:*

Fax:

Contact Name:*

Title:

E-Mail Address:*

Website Address:

LIST BUSINESS OWNERS AND KEY OFFICERS:

Name:*

Years in Position*

Position:*

Name:

Years in Position

Position:

Name:

Years in Position

Position:

Name:

Years in Position

Position:

Name:

Years in Position

Position:

How Many Years Has Your Firm Been In Business?*

Organized As a:*

Partnership

Sole Proprietorship

Joint Venture

LLC

Corporation in the State of

Other

If corporation in the state, please input

If other, please input

Organized as a (Checkbox)

MBE

DBE

WBE

SBE

Certification Agency:

Certification Number:

Does Your Firm Operate Under Any Other Name, or is Your Firm Part of Any Affiliated Companies?*

Yes

If yes, please explain

Name:

Federal ID Number:

Address:

Comments:

Type of work that your company performs: (Please check all that apply)*

01410 Testing & Inspection Services

02050 Demolition

02140 Dewatering System

02160 Shoring Systems

02200 Earthwork

02280 Soil Poisoning

02350 Piling

02380 Drill Piers

02510 Site Utilities-Water/Sewer/Gas

02630 Storm Drainage

02700 Asphalt Paving

02750 Site Concrete

02760 Parking Lot Striping

02780 Pavers

02820 Fencing & Gates

02830 Segmental Retaining Walls

02840 Traffic Signal Work

02900 Landscaping & Irrigation

03300 Turnkey Concrete Work

03410 Structural Precast

03450 Architectural Precast Material

03450 Architectural Precast Erection

03500 Lightweight Roof Deck

04000 Masonry

05000 Structural Steel Material

09900 Painting & Wallcovering Other

05700 Ornamental Handrail

05810 Expansion Joint Covers

06400 Millwork

06600 Synthetic Marble

07100 Dampproofing & Waterproofing

07240 E.I.F.S.

07250 Sprayed-On Fireproofing

07400 Metal Siding

07500 Roofing & Sheet Metal

07610 Metal Roofing

07800 Skylights

08100 H.M. Doors & Frames Material

08200 Wood Doors

08300 Overhead Doors

08700 Finish Hardware Material

08800 Glass & Glazing Work

09200 Lath & Plaster

09250 Drywall

09290 Glass Fiber Reinforced Gypsum

09300 Tile, Stone & Marble Work

09500 Acoustical Ceilings

09620 Athletic Flooring

09650 Resilient Flooring, Base & Carpet

09670 Epoxy Flooring

09800 Special Coatings Other

05500 Miscellaneous Metal Material

10200 Metal Wall Louvers

10270 Computer Flooring

10400 Graphics & Signage

10500 Lockers

10650 Operable Partitions

10674 Mobile Storage Systems

11132 Projection Screens

11150 Traffic Control Gates

11160 Loading Dock Equipment

11400 Food Service Equipment

11600 Medical/ Lab Equipment

12350 Medical/Lab Casework

12500 Window Treatment

13120 Pre-Engineered Metal Bldg

13140 Water Feature

13150 Swimming Pool

14200 Elevators & Escalators

14580 Pneumatic Tube Systems

15000 HVAC

15000 Plumbing

15300 Fire Protection

16000 Electrical

16720 Security System

16740 Voice/Data Wiring

05000 Structural Steel Erection

10000 Building Specialties Supplier Other

Other

If 09900 Painting & Wallcovering, please input

If 09800 Special Coatings, please input

If 10000 Building Specialties Supplier Other, please input

If other, please input

List the work your company normally subcontracts to others (if any):

Dollar range of subcontract work your company has manpower, equipment and ability to perform and are interested in bidding:

Low $*

High $*

Describe geographic areas in which interested in bidding:

In Arkansas:*

Other States:*

Is your company union, open shop or both?*

Explain your criteria for selecting lower tier subcontractors to perform work for your company:

List the labor organizations with which your company is signatory, if any:

List all contractor licenses and corresponding license numbers that your company holds:*

Has any contractor license held by your company ever been suspended, denied or revoked?*

Yes

If yes, please explain

Has your company ever been disbarred or precluded from public work?*

Yes

If yes, please explain

What is the total number of employees currently employed by your firm?*

How many of these employees are office management/administrative?*

How many of these employees are field management (superintendents)?*

FINANCIAL INFORMATION:

Contact Name:(Financial)

Phone

LIST OF BANK REFERENCES

Name of Bank

Bank Officer

Phone Number

Name of Bank

Bank Officer

Phone Number

Line of Credit:

Unused Line of Credit

Expiration Date:

MM slash DD slash YYYY

Provide letter of reference from bank officer (line of credit, basis extended, how much unsecured and secured, what security required, overall banking relationship, and years of relationship).

Dunn and Bradstreet Number:

Rating:

Provide a current Dunn and Bradstreet Report on your company.

Are you part of a Consolidated Group?

Yes

Company Name:

Years in Business:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Name:

Telephone:

Fax:

Has your firm or any affiliated firm or any of its owners, officers or principals ever petitioned for bankruptcy?*

Yes

If yes, please explain

Has your firm or any other organization with which your owners, officers or principals were involved during the past 5 years, ever failed to complete any work awarded or been terminated for cause?*

Yes

If yes, please explain

Are there any judgments, claims, arbitration proceedings, or suits pending/outstanding against your firm or its owners, officers or principals?*

Yes

If yes, please explain

Has your firm filed or been the subject of any lawsuits or requested arbitration or mediation with regard to construction contracts within the last three years?*

Yes

If yes, please explain

OWNER, GENERAL CONTRACTOR, SUBCONTRACTOR AND SUPPLIER REFERENCES: (MINIMUM TWO (2) EACH) OWNERS:

Name of the Company:*

Contract*

Phone Number*

Name of the Company:

Contract

Phone Number

GENERAL CONTRACTORS:

Name of the Company:*

Contract*

Phone Number*

Name of the Company:

Contract

Phone Number

SUBCONTRACTORS:

Name of the Company:

Contract

Phone Number

Name of the Company:

Contract

Phone Number

SUPPLIERS:

Name of the Company:

Contract

Phone Number

Name of the Company:

Contract

Phone Number

Bonding Agent:*

Contact:*

Telephone:*

Surety:*

Contact:*

Telephone:*

Subcontractor Single Project Limit:*

Subcontractor Aggregate Limit:*

Subcontractor Current Available Bonding Capacity:*

Number of years with current surety:*

Provide list of prior sureties if with current surety for less than two (2) years:

Has your firm or any affiliated firm ever had your work completed or supported by a surety?*

Yes

If yes, please explain

Provide letter of good standing from surety (years of relationship, largest bond, total bonding capacity)

Provide your annual revenue volume over the past three years and estimate the percent of volume bonded:

Year*

% bonded*

Year*

% bonded*

Year*

% bonded*

LIST THE PROJECTS CURRENTLY BEING CONSTRUCTED:

Project/Location*

Contract Amount*

Start Date*

MM slash DD slash YYYY

Bonded*

% Complete*

Owner/General Contractor*

LIST MAJOR PROJECTS COMPLETED IN THE LAST FIVE (5) YEARS:

Project/Location*

Contract Amount*

Start Date*

MM slash DD slash YYYY

Bonded*

% Complete*

Owner/General Contractor*

SAFETY AND HEALTH INFORMATION:

Contact Name (Safety):

Telephone:

EXPERIENCE MODIFICATION RATING LAST 3 YEARS:

Year:*

Rate Per Year

OSHA RECORDABLE INCIDENCE RATES LAST 3 YEARS:

Year:*

Rate Per Year

Have you incurred any work-related fatalities within the past 3 years? (if yes, please detail below for each fatality):*

Yes

Citation issued (if any):

Date

MM slash DD slash YYYY

Has your company received an OSHA citation in the past three (3) years for items other than those listed above?*

Yes

Number of citations:

Type and severity of citations:

Has your company received an environmental citation or notice of violation within the last three (3) years?*

Yes

Issuing Agency (s):

Describe:

Application Submission Options: If you would like this application to go to a specific person, please select that person below. This is not a required field. Your application will still be delivered to the appropriate places.

Also send this application to:

By executing below, I am acknowledging that Ideal Construction Company and the Owner will be relying upon the accuracy of this above information to assist them in determining in their discretion whether any organization can be selected bidder for individual work categories or combined work categories as established in the bid documents.

I understand the questions above and have answered truthfully and to the best of my knowledge.

Name:

Title:

(Must be an owner or officer of the company)

Date

MM slash DD slash YYYY

Signature

CAPTCHA

Trade Contractors

PREQUALIFICATION STATEMENT

GENERAL INFORMATION:

LIST BUSINESS OWNERS AND KEY OFFICERS:

FINANCIAL INFORMATION:

LIST OF BANK REFERENCES

OWNER, GENERAL CONTRACTOR, SUBCONTRACTOR AND SUPPLIER REFERENCES: (MINIMUM TWO (2) EACH) OWNERS:

GENERAL CONTRACTORS:

SUBCONTRACTORS:

SUPPLIERS:

LIST THE PROJECTS CURRENTLY BEING CONSTRUCTED:

LIST MAJOR PROJECTS COMPLETED IN THE LAST FIVE (5) YEARS:

SAFETY AND HEALTH INFORMATION:

EXPERIENCE MODIFICATION RATING LAST 3 YEARS:

OSHA RECORDABLE INCIDENCE RATES LAST 3 YEARS:

CROSSETT

TEXARKANA

LITTLE ROCK

EL DORADO