Subcontractor Prequalification Statement


Please provide complete answers to the following questions (attach additional pages if necessary). Subcontractor must qualify in order to be placed on our preferred Sub list and bid on any project. All statements made herein will be investigated and any misrepresentation of facts will result in exclusion of Contractor from Delta's bid list. Delta Construction will advise the Bidder of all final decisions on bidder qualification. Decisions will be made taking into account the information on this form as well as other information that may be independently obtained.

General Information

Company Legal Name:

DBA Name (if any):

Company Address:

Company Phone:

Company Fax:
 

Bidding Contact Name:

Bidding Contact Email:

Bidding Contact Name (2):

Bidding Contact Email (2):

State the categories/trades of work for which your company desires to be considered and indicate registration or license numbers:

State your Company's form of organization (select one):

Year Business was Inc/Formed:

How many years has your organization been in business as a Contractor or Subcontractor under your present business name?

Under what other or former names has your organization operated?

How many years experience in this type of construction work has your organization had?

The percentage of work normally completed with your own forces:

Is your Company certified as a minority or woman owned business enterprise and/or disadvantaged business enterprise (WBE, MBE, other)?


If yes, which agency:
Please submit applicable certifications

Safety

Have you had any OSHA fines within the last 3 years?


(If yes, please submit on a separate sheet the details describing the circumstances surrounding each accident.)

Have you had any jobsite fatalities within the last 5 years?


(If yes, please submit on a separate sheet the details describing the circumstances surrounding each accident.)

Please state your EMR rating for the past 3 years:
Rating: Year: Rating: Year: Rating: Year:

Claims and Suits

Has your organization ever failed to complete any work awarded to it?


(If yes, please attach a brief description of the failure including the name of the Project, the total value of the contract, the date of said failure.)

Delta Minimum Insurance Requirements:

Upon the awarding of any project work, please have your broker submit your insurance certificates via email [email protected] or fax (480) 907-1620. See Delta’s insurance requirements below.

General Liability

  • Each occurrence - $1,000,000
  • Damage to Rented Premise - $100,000
  • Medical Expenses - $5,000
  • Personal and advertising injury - $1,000,000
  • General Aggregate - $2,000,000
  • Products / Completed operations - $2,000,000

Automobile Liability

  • Combined Single Limit - $1,000,000

Umbrella Liability

  • Occurrence - $1,000,000

Workers Compensation

  • Each accident - $1,000,000
  • Disease – Each Employee - $1,000,000
  • Disease – Policy Limit - $1,000,000

Please list the 3 largest projects completed by your company in last 5 years:

Subcontractor:

Owner's Name:

Title:

Leave this empty:

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Document name: Subcontractor Prequalification Statement
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June 26, 2020 5:19 pm MSTSubcontractor Prequalification Statement Uploaded by Anne Jones - [email protected] IP 2603:8081:8208:7b00:690c:5b05:6a50:ae9e
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