Subcontractors / Vendors

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Subcontractors Pre-Qualification Form

Please complete the form below to pre-qualify with LeLack Construction.

* - required fields


Business Section


Business Type *






Have you failed to complete awarded work or been terminated for cause? Do you have any judgments, claims, arbitrations, suits or liens currently against your organization? Had any bankruptcies or reorganizations? *
  * If yes, please explain below:


Safety Section


Enter your Experience Modification Rate(EMR) for the last three years:


Do you have a written safety program? *
 

Project Information Section


Enter data from three most recent completed fiscal years:

Year

 Max. Contract Value
Completed
 Annual Company
Revenue
 Current Year Company
Workload

List license numbers in jurisdictions in which you company is legally qualified to work:

State
 License Number
 Expiration

Insurance and Bonding Section


Do you currently carry, or can you obtain the following insurance coverage? *

 
 
 
 

Bonding
Company
 Total Bonding
Capacity $
 Current Available
Bonding Capacity $

Reference Section


Project References (Within Last Three Years)


Scope Of Work Section


(Scopes Of Work That Your Company Performs) *




















Confidential Note:

The information supplied by the undersigned in this document is intended only for the use of LeLack Construction.

The undersigned certifies that the information provided herein is a clear and accurate representation of this organization. Information Supplied by:



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