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Company Name
Contact Name
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CSLB# / Class / Description
Address
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ZIP Code
Type of Work
List the categories of work you perform (Master Format/CSI Division)
Annual work volume
Average annual volume of construction work performed during the last 5 years
Type
Union
Merit
Business Organization
In what year was your organization founded?
In what year was your organization founded under its present business name?
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
Bonding Contact Name
Bonding Contact Phone
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
General Insurance
Liability Insurance
Umbrella Insurance
Automotive Insurance
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
MBE
Yes
No
Agency Issuing MBE Certificate
MBE Expiration Date
DVBE
Yes
No
Agency Issuing DVBE Certificate
DVBE Expiration Date
LGBTBE
Yes
No
Agency Issuing LGBTBE Certificate
LGBTBE Expiration Date
WBE
Yes
No
Agency Issuing WBE Certificate
WBE Expiration Date
WOSB
Yes
No
Agency Issuing WOSB Certificate
WOSB Expiration Date
SDB
Yes
No
Agency Issuing SDB Certificate
SDB Expiration Date
SBE
Yes
No
Agency Issuing SBE Certificate
SBE Expiration Date
Section 3
Yes
No
Agency Issuing Section 3 Certificate
Section 3 Expiration Date
Project References (2)
Project 1 Name
Project 1 General Contractor / Contact
Project 1 Phone
Project 1 Contract Value
Project 2 Name
Project 2 General Contractor / Contact
Project 2 Phone
Project 2 Contract Value
Material Supplier References (2)
Material Supplier 1 Name
Material Supplier 1 Contact
Material Supplier 1 Phone
Material Supplier 2 Name
Material Supplier 2 Contact
Material Supplier 2 Phone
Market Segments
List the building types / market segments you build
Market segments
Largest Jobs and year completed
Largest Jobs and Year Completed
List all geographic areas in which your company works
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