Prequalification Form SUBCONTRACTOR PRE-QUALIFICATION FORMPlease complete this form with as much detail as possible to assist us in evaluating your company's qualifications. Full Name of Company * Street Address * Mailing Address * Business Phone * Fax Number * Email Address * Autorized Signer(s)One per field, add fields as needed Authorized Signer * plus1 Add minus1 Remove Contractors License Number and State * Classification * Federal Tax ID # * Expiration Date * Type of Work Performed * Please upload a copy of your State Contractor's License * Drop a file here or click to upload Choose FileMaximum file size: 268.44MB How many years has your company been in business? * How many years with the same License Number? * If less than 5 years, please indicate former License Number and Classification What, if any, are your contract limitations? Is your Company incorporated? * YesNo In what state? * Incorporated in what year? * Names and Addresses of OfficersAdd fields as needed Name * Address * plus1 Add minus1 Remove If not incorporated, is your company a Sole Proprietorship? * YesNo As Sole Proprietorship, please provide Social Security Number * If a Partnership, please name partners:Add fields as needed. Name * Address * SSN * Phone * plus1 Add minus1 Remove Bank * Address * Contact * Phone * Name of Financial Institution * As part of any possible negotiation and prior to the potential execution of any subcontract agreement with your firm, we will at that time request specific financial information that we can verify to satisfy our due dilligence requirements. General Liability Insurance Carrier * Insurance Agent Phone * Contact * Effective Date * Expiration Date * Rating * Note: Insurance Company must have an A.M. Best Rating of A IX or better. Auto Insurance Carrier * Insurance Agent Phone * Contact * Effective Date * Expiration Date * Rating * Note: Insurance Company must have an A.M. Best Rating of A IX or better. Workers Compensation Insurance Carrier * Insurance Agent Phone * Effective State * Effective Date * Expiration Date * Name of Insured * Account Number * Does your Company have Professional Liability Insurance * YesNo Bonding Carrier (Performance/Payment) * Bonding Agent Phone * Contact * Rating * Note: Insurance Company must have an A.M. Best Rating of A IX or better.Main SuppliersAdd fields as needed Name * Address * City, State, ZIP * Contact * Phone * plus1 Add minus1 Remove Estimator * Phone * Office Manager * Phone * Accounting Contact * Phone * Are you signatory to a union agreement? * YesNo If yes, what local? * Are you willing to do prevailing wage projects? * Yes NoMBE: * Yes NoMinority Business EnterpriseWBE: * Yes NoWomen Business EnterpriseDBE: * Yes NoDisadvantage Business EnterpriseList your volume for the last three years: 2021 * 2022 * 2023 * List significant projects completed in the last three (3) years:Add fields as needed Project location * Size * Completion Date * Contact Phone * plus1 Add minus1 RemovePrimary geographical areas in which your Company holds an active Business License:Add fields as needed County or Municipality * License * Expiration Date * plus1 Add minus1 Remove Please upload a copy of your Business License (s) * Drop a file here or click to upload Choose FileMaximum file size: 268.44MBList four (4) General Building Contractor references with their contact information.Add fields as needed Name * Address * City, State, Zip * Contact * Phone * plus1 Add minus1 Remove Please upload copies of any letters of recommendation * Drop a file here or click to upload Choose FileMaximum file size: 268.44MB Number of Employees * Company Safety Program * I hereby certify thatcurrently has a written Safety Program. Signed by: * Notarized by: * Name (Print) * Name (Print) * Date * Date * Energency Contact Name * Phone * plus1 Add minus1 RemovePlease email this completed form, and a copy of requested information to:Indi Construction Partners, LLC 4031 Ellis Road, Ste. 100 Friendswood, Texas, 77546To the best of my knowledge, the information provided on this form, including attachments, is accurate. Signed: * Title: * Company name: * Date * If you are human, leave this field blank. Submit
