"*" indicates required fields Legal Name of Firm* List Any Other DBAs Address* Address City State / Province / Region Zip Type of Company* Corporation Sole Proprietor Partnership Other Date Established Month Day Year Union or Non-Union? Union Non-Union Qualified Minority Business? MBE WBE DVBE SBE Section 3 business? Yes No Experience Modification RateDIR #* Expiration Date* Month Day Year Federal ID* Scope of Work* Contractor's License #* Expiration Date* Month Day Year Estimating Contact* Phone Number*Email* Average Work in Years (Last 5 Years) Work under contract Average project size in place last year BONDING AND INSURANCE INFORMATIONIs Subcontractor able to provide bid, payment and performance bonds? Yes No Bonding Company A.M. Best Rating Does your firm use any Employee Leasing Companies? Yes No Can your General Liability, Auto and Umbrella policies name General Contractor and Owner as Additional Insured? Yes No Can your GL, WC and Umbrella policies give Waiver of Subrogation to Contractor and Owner? Yes No Attach all required supporting documents Drop files here or Select files Accepted file types: pdf, Max. file size: 50 MB, Max. files: 10. COMPLETED PROJECTS: LIST LAST 3 PROJECTS COMPLETEDProject #1Project #2Project #3CAPTCHA
