Pre-Qualify - Concord General Contracting

General Subcontractor Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Fax

Email*

Email 2 (optional)

Email 3 (optional)

Subcontractor Trades*

Organization

How many years has your organization been in business as a contractor?*

How many years has your organization been in business under its present name?*

Under what other or former names has your organization operated?*

Licensing

List license number(s) registered with registrar of contractors for the State of Arizona. Please separate each license with a comma.*

Please provide your D & B (Duns) number:*

Experience

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

No
Yes

If Yes, provide details:*

Are there any judgments, claims, arbitration proceeding with regard to construction contracts within the last five years?*

No
Yes

If Yes, provide details:*

Has your organization filed any lawsuits or requested arbitration with regard to construction contracts within the last five years?

No
Yes

If Yes, provide details:*

Does your organization have any vendors with unpaid or disputed claims?*

No
Yes

If Yes, provide details:*

Within the last five years, has any officer or principal of your organization ever been an officer or principal of another organization when it failed to complete a construction contract?*

No
Yes

If Yes, provide details:*

List the major projects your organization has completed in the past two years, giving the name of the project, owner, general contractor, architect, contract amount.*

State average annual amount of construction work performed during the past three years.*

Average contract size $ (last 2 years)*

Largest contract $ (last 2 years)*

References

Reference 1 - Company*

Reference 1 - Contact*

First Last

Reference 1 - Phone*

Reference 2 - Company*

Reference 2 - Contact*

First Last

Reference 2 - Phone*

Reference 3 - Company*

Reference 3 - Contact*

First Last

Reference 3 - Phone*

Insurance Information

Company Name*

Agent Name*

First Last

Phone*

Do you authorize us to contact your agent regarding your insurance status?

Yes
No

Surety (if applicable)

Company Name

Agent Name

First Last

Address

Street Address City State ZIP Code

Phone

Subcontractor Pre-Qualification Form – Step 1 of 2

General Subcontractor Information

Organization

Licensing

Experience

References

Insurance Information

Surety (if applicable)