Subcontractor PreQualification Statement

HomeSubcontractor PreQualification Statement

ACA is continually looking to grow and diversify its base of qualified subcontractors. In order to be considered please complete the following Subcontractor Prequalification Form.
The following items will also be required after a subcontract is considered for your organization:

  • IRS Form W-9
  • Copy of your current Occupational license and State license.
  • Certificates of the following insurances in specified amounts:
    a. General Liability – $1,000,000
    b. Worker’s Compensation – statutory limits = $500,000

General Information


Legal Company Name:

Date:

Physical Address:

Mailing Address:

Phone:

Fax:

Email Address:

Web Address:

Federal Tax ID:

Years in Business Under Present Name:

Geographic Area of Business Operations:

Contracting Scope:

AIA Divisions for which your company is qualified/licensed to perform:

Select Type of Business:

Principals of Firm/Title:

Total Number of Permanent Employees:

Preferred MINIMUM Project Size Your Company Seeks:

Preferred MAXIMUM Project Size Your Company Seeks:

Work History


List at least four (4) of the most significant projects your company worked on in the past 12 months.


PROJECT 1

Project Name:

General Contactor:

Address:

Contact:

Contract Amount:

Phone:

Fax:


PROJECT 2

Project Name:

General Contactor:

Address:

Contact:

Phone:

Fax:

Contract Amount:


PROJECT 3

Project Name:

General Contactor:

Address:

Contact:

Phone:

Fax:

Contract Amount:


PROJECT 4

Project Name:

General Contactor:

Address:

Contact:

Phone:

Fax:

Contract Amount:

Licenses


License Number:

Jurisdiction:

Category:

License Number:

Jurisdiction:

Category:

License Number:

Jurisdiction:

Category:

Safety


Does your firm have a written safety program:
 Yes

 No

What is your Worker’s Comp Experience Mod Rate:

In the previous 3 years, has your firm been cited for a serious violation (OSHA):
 Yes

 No

If yes, list violations:

Insurance and Bonding


Value of work presently bonded:

Total Bonding Capacity:

Bonding Surety:

Bonding Agent:

Contact:

Phone:

Insurance Agent:

Contact:

Phone:

Bank References


Bank:

Address:

Contact:

Phone:

Fax:

Account Number:

Has your firm failed to complete a contract:
 Yes

 No

Has your firm been involved in bankruptcy or reorganization:
 Yes

 No

Does your firm have any pending judgement claims or suits:
 Yes

 No

Contact Information


General Contact

Name/Title:

Phone:

Cell Phone:

Fax:

Email:

Estimating Contact

Name/Title:

Phone:

Cell Phone:

Fax:

Email:

Office Contact

Name/Title:

Phone:

Cell Phone:

Fax:

Email: