Subcontractor Prequalification Form.

General Business Information
Legal Name of Business:
Years in Business:
Street Address:
City:
State:
Zip:
Mailing Address:	(if different than street address)
Phone (with area code):
Fax (with area code):
Email:
Website:
Contact Name:
Title:
Email:
Contact Name:
Title:
Email:
Trades Performed:
Union Affiliation (if any), list locals:
Minority Classification:	MBE WBE DBE None
Certifying Agencies:
Average Number of Employees/No. of Regular Trades People:
Average Contract Size:
Minimum Contract Size:
Maximum Contract Size:
References
Please identify two General Contractors with whom you have worked in the past two years
Company Name:
Contact:
Phone:
Company Name:
Contact:
Phone:
Financial Background
Last Year's Gross Sales:
This Year's Projected Sales:
Aggregate Bonding Capacity:
Single Job Bonding Capacity:
Bonding Agent:
Contact:
Phone:
Insurance Agent:
Contact:
Phone:
Bank Name:
Contact:
Phone:
Will your insurance coverage provide for the naming of the Owner and General Contractor as additional insured on a primary non-contributory basis with a waiver of subrogation on behalf of the additional insured by the worker's compensation carrier?   Yes No
The above information is true and correct to the best of my knowledge
Name:
Title:
Date:
Submit this form to:	FHPSNN Chicago FHPSNN Florida FHPSNN California