Subcontractor Form Subcontractor Form *Name company(Required) *Address Line 1(Required) Address Line 2 StateStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificAddress ZIP / Postal Code HTML Select Country Phone Code List with Flags HTML Select Country Phone Code List with Flags Website / URL Main ContactName(Required) First Last Role/Title *Type of Company(Required)*Type of CompanyFirst ChoiceSecond ChoiceThird Choice*List of trade(s) of work performed by company(Required) *Federal Tax ID #(Required) NAICS Code DUNS # *Average contract Value last three (3) years(Required) *Largest single contract completed in last three (3) years(Required) Is company directly or indirectly signatory to any labor agreements? Yes No Is company able to bond projects Yes No *Current Experience Modifier (EMR %)(Required) Effective Date (mm/yy) MM slash DD slash YYYY Is the company certified? Check all that apply: Small Business Veteran Owned Business Minority Owned Business Service Disabled Veteran Owner Woman Owned Business HUB Zone Business Small Disadvantaged Business Firm Reference 1Firm Reference 1 Company Name *Address Line 1(Required) *Address Line 2(Required) StateStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code Name(Required) First Last Email(Required) Firm Reference 2Firm Reference 2 Company Name *Address Line 2(Required) *Address Line 2(Required) StateStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code Name(Required) First Last Email(Required) Firm Reference 2Firm Reference 2 Company Name *Address Line 2(Required) *Address Line 2(Required) StateStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code Name(Required) First Last Email(Required) Safety InformationIs company part of any OSHA partnership? Yes No Does company conduct weekly, documented safety audits? Yes No Does company have a safety management program and safety manual? Yes No Does company have a full time safety manager/director? Yes No No Do company trade personnel begin each day with a safety meeting? Yes No Does company use project specific safety plans? Yes No Other Information In the past five years, has company: Yes Had any liens filed against it by any of its subcontractors, suppliers or taxing authority? Yes No Had any judgments, claims, arbitration proceedings or suits against it or its officers? Yes No Filed any lawsuits or request arbitration with regard to a construction contract? Yes No Ever failed to complete a contract, been defaulted, or had a contract terminated? Yes No Had liquidated damages assessed against it upon completion of a project? Yes No Had any of its key people been a party to a bankruptcy or reorganization proceeding? Yes No Had any of its key people been investigated for or found to have committed a violation of any labor laws? Yes No Had active or inactive exclusions associated with it or any key personnel as determined by the Federal Government Systems for Award Management (S.A.M.)? Yes No Please provide details explaining any yes answers:W-9 Form Drop files here or Select files Max. file size: 32 MB. Insurance Certificate Drop files here or Select files Max. file size: 32 MB. EMR Letter Drop files here or Select files Max. file size: 32 MB. Company Information Drop files here or Select files Max. file size: 32 MB. Additional Information Drop files here or Select files Max. file size: 32 MB. Please provide details explaining any yes answers:SignatoryName(Required) First Last Title Today's Date Δ
