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.
Company Legal Name:
DBA Name (if any):
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):StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington D.C.West VirginiaWisconsinWyoming
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)?YesNoIf yes, which agency: Please submit applicable certifications
Have you had any OSHA fines within the last 3 years?YesNo(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?YesNo(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:
Has your organization ever failed to complete any work awarded to it?YesNo (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.)
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.
Please list the 3 largest projects completed by your company in last 5 years:
Leave this empty:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: Subcontractor Prequalification Statement
Agree & Sign