Allgire General Contractors

Subcontractor Prequalification Form

Business Information

Company name

Contact name

Street Address

State

Phone No.

Email address

Website

CSLB #, Class & Description:

Type of Work

Please list the categories of work (Master Format/CSI Division) that your company primarily self performs:

Average annual volume of construction work performed during the last 5 yrs:

Union Merit

Business Organization

In what year was your organization founded?

In what year was your organization founded under its present business name?

Under what other or former names has your organization operated?

FEIN / TAX ID#

Entity type Corporation Individual Partnership LLC

Name of owner

Financial Information

Is your company bondable? Yes No

Name of Bonding Agent Company

Contact Name

Contact Phone No.

Bonding rate (percentage)

Bonding Capacity, Single Project Amount

Bonding Capacity, Aggregate Amount

Bank Name / Contact

Trade references

Safety / Insurance

Does your company have a formal safety program? Yes No

Does your company have a safety consultant? If so, who?

Does your company have an Injury and Illness Prevention Program (IIPP)? Yes No

List EMR (Experience Modification Rate) for the past 3 years:

State the amount of insurance coverage carried by your firm:

General

Liability

Umbrella

Automotive

Can you furnish Worker's Comp with Waiver of Subrogation endorsement? Yes No

Can you furnish additional insured endorsements (CG2010 1185 or equivalent)? Yes No

Minority Designations

WBE Yes No

Agency Issuing Certificate

Expiration Date

WOSB Yes No

Agency Issuing Certificate

Expiration Date

8(a) Yes No

Agency Issuing Certificate

Expiration Date

SDB Yes No

Agency Issuing Certificate

Expiration Date

DV Yes No

Agency Issuing Certificate

Expiration Date

MBE Yes No

Agency Issuing Certificate

Expiration Date

Project References (3)

Reference 1

Project Name

General Contractor / Contact

Phone #

Contract Value

Reference 2

Project Name

General Contractor / Contact

Phone #

Contract Value

Reference 3

Project Name

General Contractor / Contact

Phone #

Contract Value

Material Supplier References (3)

Reference 1

Material Supplier

Contact

Phone #

Reference 2

Material Supplier

Contact

Phone #

Reference 3

Material Supplier

Contact

Phone #

Market Segments

Please approximate the percentage of work your company does in each market segment

Tenant Improvement

High Rise Residential (> 5 stories)

Hotel / Motel

Low Rise Residential (< 4 stories) and SFR

Commercial / Retail

Largest jobs and year completed

Is your company capable of performing under a Design/Build delivery system?

Yes No

Please list Trade Organizations of which your company is a member

Does your company implement Building Information Modeling (BIM)?

Yes No

Is your company a USGBC member or similar?

Yes No

Geographic Areas

Please list all geographic areas in which your company works