SUBCONTRACTORVENDOR PRE-QUALIFICATION STATEMENT by vivi07

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									Project Name: Sundt Contact:
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SUBCONTRACTOR PRE-QUALIFICATION STATEMENT
Overview: SubQual, LLC provides prequalification services on subcontractors that wish to be included in the bid list of the following general contractors, Sundt Construction, Inc. and Summit Builders. It is the policy of these general contractors to prequalify the subcontractors prior to bidding on any of their projects. From the information provided, each general contractor will independently establish their maximum per project contract limit for subcontractors. Establishment of this maximum subcontract value is a requirement of the subcontractor default insurance carrier of these general contractors. (Subcontractor default insurance is provided in-lieu of a bond on the subcontractor.). Your prequalification status must be updated annually. Questions can be directed to our Pre-qualification Department at (800) 407-6192 or E-Mail to prequal@subqual-llc.com. This statement can be downloaded as a Word document or prepared and submitted on-line in our Subcontractor Portal at www.subqual-llc.com.

Please complete as it appears on your State Contractor’s License: Legal Name of Firm: DBA: Address:

State: State: State: State:

(city, state, zip) License No: License No: License No: License No:

Class(es): Class(es): Class(es): Class(es):

Expiration: Expiration: Expiration: Expiration:

Shipping Address: (city, state, zip) Mailing Address: (city, state, zip) Phone: Web Address : Fax:

Provide names and titles of your firm’s principal contacts:
PRINCIPAL CONTACT: Phone: E-Mail: ESTIMATING CONTACT: Phone: E-Mail: Fax: TITLE: Fax: TITLE:

SubQual, LLC

Subcontractor Prequalification Web Form, rev. 11/03/09

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INDICATE THE AREA(S) THAT YOU PREFER TO WORK IN:

Northern Arizona (including Phoenix and Casa Grande metro areas) Southern Arizona (including Tucson and Yuma metro areas) Northern California (including Sacramento metro areas) Southern California (Los Angeles and San Diego metro areas) Nevada (including Reno metro areas) Federal Work – list states ______________________________________________________________

List CSI Divisions/Trades (see page 5): Are you willing to bid on prevailing wage projects? Yes No

For Arizona subcontractors only, please answer the following two questions:
Do you comply with all federal immigration laws per A.R.S. 41-4401? Do you use the E- Verify program (A.R.S. 23-214, subsec. A)? Yes Yes No No

Your Company’s Minority Status:
Please check all that may apply and provide proof of certifications*: County, City, State and Transportation Departments: DBE ................... Disadvantaged Business Enterprise* DVBE……………Disabled Veterans Business Enterprise* MBE ................... Minority Business Enterprise* SBE ................... Small Business Enterprise* WBE .................. Woman Business Enterprise* Federal Contracts (DoD) / Small Business Administration:
(Small Disadvantaged Businesses and HubZone Businesses must be certified by the SBA and registered in the CCR /Pro-Net system. For more information visit www.ccr.gov)

HBCU/MI .......... Historically Black Colleges Universities/ Minority Institutions* HUBZone-SB..... Historically Underutilized Business Zone* LB ...................... Large Business SB ...................... Small Business* SBA 8(a) ............ Small Business Administration 8(a)* SDB ................... Small Disadvantaged Business* SD-VOSB .......... Service Disabled Veteran Owned Small Business* VOSB ................ Veteran Owned Small Business* WOSB ............... Women Owned Small Business* Minority Ownership Native American (includes American Indian, Eskimo, Aleut & Native Hawaiian) ANC-LB…………Alaskan Native Corporation and Indian Tribes – Large Business ANC………...…..Alaskan Native Corporation and Indian Tribes
SubQual, LLC Subcontractor Prequalification Web Form, rev. 11/03/09 Page 2 of 5

YEAR

ANNUAL SALES

LARGEST SINGLE CONTRACT VALUE

GENERAL CONTRACTOR

2008 2007 2006

$ $ $

$ $ $

Safety: List Experience Modification Rate 2008 Federal Tax ID: Dunn & Bradstreet Number: Current Bonding and Banking Information: Surety Company: Contact Person: Name of your bank: Address: Contact Person: Line of credit: $ References:
List three major suppliers:
Company Name: Address: Phone: Contact: Company Name: Address: Phone: Contact: Company Name: Address: Phone: Contact: Fax: Fax: Fax:

2007

2006

Broker: Phone:

Phone: Unused portion: $

Expiration date:

SubQual, LLC

Subcontractor Prequalification Web Form, rev. 11/03/09

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List three General Contractors:
Company Name: Address: Phone: Contact: Company Name: Address: Phone: Contact: Company Name: Address: Phone: Contact: Fax: Fax: Fax:

IN ORDER TO BE PREQUALIFIED FOR MORE THAN $50,000, THE FOLLOWING MUST BE PROVIDED ANNUALLY:
 A letter from your Surety outlining the single project and aggregate amounts for which they will issue a performance and payment bond (we are not asking for a bond).  A copy of your latest (consolidated) financial statements, i.e., Balance Sheet, Income Statement, etc., prepared by an outside accounting firm (Audited, Reviewed or Compiled Financial Statements) AND a copy of your most recent internal financial statements.  Please be assured your financial information will be kept confidential in accordance with our Subcontractor Portal Privacy Statement. For more information see www.subqual-llc.com.  Your pre-qualification status cannot be determined until the pre-qualification statement is accurately completed, a letter from your surety is received and the necessary financial statements are provided. By signing the SubQual, LLC Subcontractor Pre-Qualification Statement (“Statement”) you authorize the release of the submitted information as set forth in the Statement to Sundt Construction, Inc. (“Sundt”) and Summit Builders (“Summit”). This information will be used by Sundt and Summit to independently establish their maximum per project contract limit for your company. Please note, the actual financial statements you provide to SubQual are kept confidential and are not open to the GC’s or any other party unless SubQual receives written permission from an officer of your company.
Completed by: Title: Phone number: Email: Date: SUBMIT TO: SubQual, LLC Attn: Pre-Qualification Department P.O. Box 80577 San Diego, CA 92138 Or by Confidential Fax: (800) 407-6194 Or by Confidential E-mail: prequal@subqual-llc.com Page 4 of 5

SubQual, LLC

Subcontractor Prequalification Web Form, rev. 11/03/09

CSI Divisions/Trades:
(Please circle or check the trade(s)that your company is interested in bidding)
1000 1140 1400 1430 1435 1440 1480 1530 2110 2115 2145 2210 2220 2250 2300 2310 2360 2455 2475 2500 2620 2632 2660 2770 2780 2790 2815 2820 2830 2840 2870 2890 2895 2900 2905 3150 3200 3300 3400 3520 3530 4000 4400 4720 4910 5120 5140 5150 5200 5300 5330 5510 5520 5530 5560 5650 5700 General Conditions Survey & Layout Material Testing Security Guard Firms Chemical Toilets Cleaning Services Jobsite Trailers Temporary Fencing Excav., Removal, Haz. Matl U.G Storage Tank Removal Groundwater Treatment Sys. Subsurface Investigation Demolition Shoring And Underpinning Earthwork Asphalt Paving Soil Treatment / Termite Cntrl Driven Piles Caissons Site Utilities Drywells Storm Drainage Ponds And Reservoirs Curbs And Gutters Unit Pavers Athletic/Recreation Surfaces Fountains Fences And Gates Retaining Walls Striping Site Furnishings Traffic Signs And Signals Markers And Monuments Planting, Landscape & Irrig. Native Plant Salvage Concrete Accessories Concrete Reinforcement Cast-In-Place Concrete Pre-Cast Concrete L.W. Conc. Roof Insulation Gypsum Concrete Masonry Stone Cast Stone Unit Masonry Restoration Structural Steel Structural Aluminum Wire Rope Assemblies Metal Joists Metal Deck Aluminum Deck Metal Stairs And Ladders Handrails And Railings Gratings Metal Castings Railroad Track/Accessories Ornamental Metal 5810 6110 6250 6400 6415 6500 6600 7100 7160 7170 7180 7210 7240 7410 7510 7570 7620 7720 7810 7920 8110 8210 8300 8320 8360 8460 8500 8600 8700 8800 8950 9210 9250 9310 9400 9510 9650 9670 9680 9900 10115 10160 10200 10260 10270 10300 10350 10400 10430 10500 10520 10550 10605 10650 10705 10800 10880 Expansion Joint Covers Wood Framing Prefinished Paneling / FRP Architectural Woodwork Countertops Structural Plastics Plastic Fabrications Dampproofing/Waterproofing Cementitious & Reactive W.P. Bentonite Waterproofing Traffic Coatings Building Insulation Exterior Insul. Finish Syst. Metal Roof And Wall Panels Built-Up Bituminous Roofing Coated Foamed Roofing Sheet Metal Flashing/Trim Roof Accessories Applied Fireproofing Joint Sealants Steel Doors And Frames Wood Doors Specialty Doors / Won Doors Detention Doors And Frames Overhead Doors Automatic Entrance Doors Windows Skylights Hardware Glazing Translucent Wall/Roof Assem. Cement Plaster Gypsum Board Ceramic Tile Terrazzo Acoustical Ceilings Resilient Flooring Fluid Applied Flooring Carpet Paints And Coatings Markerboards Metal Toilet Compartments Louvers And Vents Wall And Corner Guards Access Flooring Fireplaces And Stoves Flagpoles Identification Devices Exterior Signage Lockers Fire Protection Specialties Postal Specialties Wire Mesh Partitions Operable Partitions Exterior Sun Control Devices Toilet, Bath, Laundry Access. Scales 11130 11150 11160 11170 11190 11200 11210 11220 11225 11230 11240 11250 11260 11270 11285 11295 11300 11310 11320 11330 11335 11340 11345 11350 11360 11365 11370 11375 11380 11385 11390 11400 11600 12310 12320 12490 12600 13110 13120 13150 13200 13230 13280 13400 13700 14200 14300 14550 14600 15300 15400 15700 15935 16000 16700 Audio-Visual Equipment Parking Control Equipment Loading Dock Equipment Solid Waste Handling Equipment Detention Equipment Water Treatment Equipment Supply/Treatment Pumps Mixers And Flocculators Clarifiers Water Aeration Equipment Chemical Feed Equipment Water Softening Equipment Disinfectant Feed Equipment Fluoridation Equipment Hydraulic Gates Hydraulic Valves Waste Treatment/Disposal Equip. Sewage And Sludge Pumps Grit Collecting Equipment Screening/Grinding Equipment Sedimentation Tank Equipment Scum Removal Equipment Chemical Equipment Sludge Hand./Treatment Equip. Filter Press Equipment Trickling Filter Equipment Compressors Aeration Equipment Sludge Digestion Equipment Digester Mixing Equipment Pkg. Sewage Treatment Plants Food Service Equipment Laboratory Equipment Manufactured Metal Casework Manufactured Wood Casework Window Treatments Systems Furniture Cathodic Protection Pre-Engineered Structures Swimming Pools Storage Tanks Digester Covers/Appurtenances Hazardous Material Remediation Measurement/Control Instrument Security Access/Surveillance Elevators Escalators And Moving Walks Conveyors Hoists And Cranes Fire Protection Piping Plumbing Fixtures/Equipment Heating, Ventilating, A/C Equip. Building Systems Controls Electrical Communications

SubQual, LLC

Subcontractor Prequalification Web Form, rev. 11/03/09

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