Subcontractor Information Form

All Fields are Required Unless noted otherwise with *

Company Information  
Business Name:
 Business Type:
Primary Estimating Contact
First Name:
 Last Name:
 Email: *
 Cell:
Secondary Estimating Contact
First Name:
 Last Name:
 Email: *
 Cell:
 

Mailing Address:

 City:
 State:
Zip:
 Country:
 Phone:
 Fax:
Federal ID#
 Business Start up Year:
    
License #: *

 State:

 Exp:

  
 
 

Area(s) of Work:
View Map View Map View Map View Map View Map    
Arkansas Kansas Oklahoma Missouri Texas Nationwide Wal-Mart
NW NW NW NW Amarillo
NE NE NE NE Lubbock    
SW SW SW SW Odessa    
SE SE SE SE Waco    
Little Rock Wichita OKC Kansas City Austin    
  Topeka Tulsa Central Missouri San Antonio    
      St. Louis Houston    
        Abilene    
        Texas / Mexico Border    
        Longview    

CSI Code(s) Minority Classification:
Review codes from above dropdown box. Enter multiple codes below seperated by a comma.

Bonding Information:
Agent/Broker Name:
 Contact Name:
Address:
 City:
 State:
 Zip:
Contact Phone:
 Fax:
    

Surety:      
Name:
 Contact Name:
Address:
 City:
 State:
 Zip:
Contact Phone:
 Fax:
    

NCCI-EMR For Last 3 Years
Year Rate

OSHA 300-A Summary for Last 3 Years
Year: # of Hours worked in a calendar year Total # of Recordable incidents




Limits of Insurance
General Liability:
 Auto Liability:


 Work Comp:


 Umbrella:

Single Project Bonding Capacity: ($) Total Program Bonding Capacity: ($) Largest Completed Project: ($) Largest Backlog of Uncompleted Work: ($)

If we enter into contract for a job we will need the following before the work should start:
  1. Subcontractor Current Work in Process Report
  2. Current Certificate(s) of Insurance
  3. W9
  4. References (Min 3)

Would you like to continue to be in our bidding system?  Yes No

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement

 

 

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