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Houston Area Industrial Sales Employment

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					                Greater Baton Rouge Industry Alliance
                    Pre-Qualification Add-on Form
(To be used in conjunction with the Houston Area Safety Council
        and Southwest LA Safety Council PQF Systems)
Home Office Physical Address                                              Remit To:

Home Contact                                                              Remit Name
Physical Address 1                                                        Remit Address 1
Physical Address 2                                                        Remit Address 2
City                                                                      Remit City
State/Province                                                            State/Province
Zip                                                                       Zip
Phone Number                                                              Remit Phone
E-mail                                                                    Remit Fax
                                                                          Remit E-mail



After Hours/Weekend/Holiday Contact
Home Contact
Physical Address 1
Physical Address 2
City
State/Province


Technological Capabilities
    Do you have Virtual Office capabilities?


Employer Paid Benefits
    Do you have or provide?
       Hourly                  Salary                                           Hourly            Salary
                                                 Health
                                                 Insurance                                                  Paid Sick Leave
                                                 Dental
                                                                                                            Education Reimbursement
                                                 Insurance
                                                 Life
                                                 Insurance                                                  Employee Profit Sharing
                                                 Disability
                                                 Insurance                                                  401K or other retirement plan
                                                 Paid
                                                 Vacation                                                   Pension Plan
                                                 Paid
                                                 Holiday
                                                 Others:




                                       Greater Baton Rouge Industry Alliance Inc. Last Update 9/21/2007
                     5800 One Perkins Place Dr. Suite 5-A | Baton Rouge, LA 70808 | Phone 225-769-0596 | Fax 225-769-0289

                                                                                                                              Page 1
                    Greater Baton Rouge Industry Alliance
                        Pre-Qualification Add-on Form
(To be used in conjunction with the Houston Area Safety Council
        and Southwest LA Safety Council PQF Systems)
Bonding Capacity
Total ($)
Available ($)
Bonding Company
Normally Used
Bonding Rate % or per
$1000


Insurance Carriers
                                                                                 Limit of
                                                    Carrier                    Coverage ($)                      Expiration Date of Policy
            Workers Compensation
       Contractors General Liability
               Excess Liability
       Envir/Pollution (if applicable)
      Errors/Omissions/Prof. Liability
                    Auto
                    Other


Safety
Do your safety programs include training or medical monitoring for
the following?
Chromium
                                  Yes
Electrical Safety
(NFPA 70E)                           Yes

Work Permit Systems
(for such as LOTO,                   Yes
Confined Space, etc.)




                                          Greater Baton Rouge Industry Alliance Inc. Last Update 9/21/2007
                        5800 One Perkins Place Dr. Suite 5-A | Baton Rouge, LA 70808 | Phone 225-769-0596 | Fax 225-769-0289

                                                                                                                               Page 2
               Greater Baton Rouge Industry Alliance
                     Pre-Qualification Add-on Form
   (To be used in conjunction with the Houston Area Safety Council
           and Southwest LA Safety Council PQF Systems)

Locations of Work Preference (Check „Yes‟ if your company works in the area, „B‟ if you have a branch in the area.)
                                                                License
                Region                           Yes      B     No. (If                              Yes     B
                                                                Applicable)          Region                        License No. (If Applicable)
               Alabama                                                           Massachusetts
                Alaska                                                              Michigan
               Arkansas                                                            Minnesota
               Arizona                                                             Mississippi
              California                                                            Missouri
               Colorado                                                             Montana
             Connecticut                                                            Nebraska
              Delaware                                                              Nevada
                                                                                     New
                Florida
                                                                                   Hampshire
               Georgia                                                             New Jersey
                Hawaii                                                            New Mexico
                Idaho                                                              New York
                                                                                     North
                Illinois
                                                                                    Carolina
               Indiana                                                            North Dakota
                 Iowa                                                                  Ohio
                Kansas                                                             Oklahoma
              Kentucky                                                               Oregon
              Louisiana                                                           Pennsylvania
                Maine                                                             Rhode Island
                                                                                     South
              Maryland
                                                                                    Carolina




                                             Greater Baton Rouge Industry Alliance Inc. Last Update 9/21/2007
                           5800 One Perkins Place Dr. Suite 5-A | Baton Rouge, LA 70808 | Phone 225-769-0596 | Fax 225-769-0289

                                                                                                                                  Page 3
                   Greater Baton Rouge Industry Alliance
                        Pre-Qualification Add-on Form
  (To be used in conjunction with the Houston Area Safety Council
          and Southwest LA Safety Council PQF Systems)
Locations of Work Preference (continued)
        Region             Yes      B     License No. (If Applicable)                   Region             Yes     B     License No. (If Applicable)
    South Dakota                                                                      Washington
      Tennessee                                                                     West Virginia
         Texas                                                                        Wisconsin
         Utah                                                                          Wyoming
       Vermont                                                                    Dist. Of Columbia
       Virginia                                                                       Puerto Rico


International
        Region             Yes      B     License No. (If Applicable)                   Region             Yes     B     License No. (If Applicable)
        Mexico                                                                            Asia
    South America                                                                       Europe
       Australia                                                                         NWT
        Africa                                                                          Ontario
        Alberta                                                                         Quebec
   British Columbia                                                                 Saskatchewan
       Manitoba                                                                          Yukon




Fabrication Capabilities for Structural Steel, Pipe, and Vessels

Do you have a related division or subsidiary engaged in shop production?                                             Yes


If yes, complete this section. If no, skip to the next section.
Is your shop for contract-related work, or will you accept stand-alone bids?                                         Yes, contract work only.
Name and address of shop (if different than that of contractor):




                                            Greater Baton Rouge Industry Alliance Inc. Last Update 9/21/2007
                          5800 One Perkins Place Dr. Suite 5-A | Baton Rouge, LA 70808 | Phone 225-769-0596 | Fax 225-769-0289

                                                                                                                                  Page 4
                    Greater Baton Rouge Industry Alliance
                        Pre-Qualification Add-on Form
 (To be used in conjunction with the Houston Area Safety Council
         and Southwest LA Safety Council PQF Systems)
Fabrication Capabilities for Structural Steel, Pipe, and Vessels (cont.)
Average number of shop employees?                                                        Direct Labor
                                                                                              Indirect
Average number of shop engineers?
                                                                                                Labor
Average number of drafters?
Do you have spool drawing capability?                       Yes                               Select the activities you would be capable of
                                                                                               performing in your shop and indicate the
If yes, in house?                                           Yes                                 percentage of your work in these areas.
Average number of shop inspectors?                                                             %           Yes
Union affiliation, if any?                                                                                            Sheet metal fabrication
If union, labor contract expiration data?                                                                             Light and medium plate fab.
Annual sales volume from shop production?                                                                             Structural steel fabrication
                                                                                                                      Misc. steel (platforms,
Number of square footage in fabrication area?
                                                                                                                      ladders, handrails, etc.)
                                                                                                                      Pipe spool fabrication
                                                                                                                      Pipe forming and bending
                                                                                                                      Vessel fabrication
Detail, Skids, Spool Draw Capabilities
                             Indoor      Outdoor                Subcontract                       Are you an ASME code shop?               Yes
Sandblast Facilities                                                                                       Section(s) and Stamp(s)
 Painting Facilities
                                                                                                                           Other Codes
Largest Crane Capacity
Does your organization do steel
                                                                                                                    Code Inspection Agency
detailing?
Does your organization build
process skids?                                Yes
What kind of skids does your
organization have experience with?
                                                                                         Metals with which you are qualified to
Largest practical size vessel, column:
                                                                                         work:
  Diameter (feet)                                                                         Boiler steel                   Copper Alloys
                                                                                           Stainless
    Length (feet)
                                                                                             steel                       Nickel Alloys
   Weight (lbs)                                                                           Aluminum                          Titanium
Size stress relieving
                                                                                             Other
       furnace
 Capacity plat rolls
 Do you have rail
                              Yes
     into plant?

                                           Greater Baton Rouge Industry Alliance Inc. Last Update 9/21/2007
                         5800 One Perkins Place Dr. Suite 5-A | Baton Rouge, LA 70808 | Phone 225-769-0596 | Fax 225-769-0289

                                                                                                                                 Page 5
                  Greater Baton Rouge Industry Alliance
                      Pre-Qualification Add-on Form
 (To be used in conjunction with the Houston Area Safety Council
         and Southwest LA Safety Council PQF Systems)
Quality Management Commitment
Does the organization have a Written Quality Management System?                                  Yes
       If so, is it based on ISO?                                                                Yes
       Is it registered?                                                                         Yes
       To what standard?

Are all employees trained in the applicable quality policies?                                    Yes
Does the organization establish annual and long-term quality goals?                              Yes
Does the organization include individuals dedicated full-time to quality?                        Yes
       If so, what are their titles?
       Are they certified?                                                    Yes
       Where in the organization do these positions report?

Does your quality manager visit each major job prior to the project
beginning?                                                                                       Yes

Does corporate or senior management perform quality audits?                                      Yes

Do job descriptions for supervision and management include quality
responsibilities?                                                                                Yes

Do you have a process/form for evaluating the quality performance of
subcontractors prior to hire?                                                                    Yes

Does your organization have a program for rewarding and recognizing
outstanding quality performance by individuals, groups, or teams?                                Yes

Does your organization have a disciplinary system for unacceptable quality
performance by an individual?                                                                    Yes

Are projects integrated into the organization‟s quality system?                                  Yes
       If yes, please explain.

Do you have a process to measure standard metrics or project job
performance?                                                                                     Yes
       If yes, please explain.

Is continuous improvement a part of your quality management system,
including identification of root causes and a corrective action system?                          Yes



                                             Greater Baton Rouge Industry Alliance Inc. Last Update 9/21/2007
                           5800 One Perkins Place Dr. Suite 5-A | Baton Rouge, LA 70808 | Phone 225-769-0596 | Fax 225-769-0289

                                                                                                                                  Page 6
                 Greater Baton Rouge Industry Alliance
                     Pre-Qualification Add-on Form
 (To be used in conjunction with the Houston Area Safety Council
         and Southwest LA Safety Council PQF Systems)
Security
Is your company screening employees with the Security Passport system
administered by the Safety Council of the LA Capital Area?                                                             Yes

If not, please answer the following:
Do you perform background investigations and screening on your employees
using another program such as Safety Council Security Consortium (SCSC)                                       SCSC        NABSC
or North American Background Screening Consortium (NABSC)?                                                            Other

Does the background investigation include the following:
                    Verification of Social Security Number?                                                            Yes
                        Verification of Address?                                                                       Yes
                        Federal criminal record check (7 years, all residential
                        addresses)?                                                                                    Yes
                        If checking for other than 7 years, what time frame?
                        County/Parish criminal record check?                                                           Yes
                        Employment verification of last employer?                                                      Yes
                        Education verification of the highest level attained?                                          Yes

Do you “grandfather” or exclude any employees from the background
                                                                                                                       Yes
investigations?
If so, how?

Does your organization restrict employees from working on Owner premises if in the seven (7) year period ending on
the date of the background investigation an employee has been convicted of any of the following:

A crime referred to in Section 46306, 46308, 46314, or 46315 of Title 49 of the United States Code (U.S.C.) or
Chapter 465 of Title 49 or Section 32 of Title 18?                                                                                        Yes
                                                                                     Unlawful possession, sale,
              Murder                                                             distribution, or manufacture of an
                                                  Yes                                    explosive weapon?                                Yes
   Assault with intent to murder                  Yes                                         Extortion                                   Yes
            Espionage                                  Yes                                           Armed Robbery                        Yes
                                                                                          Distribution of, or intent to distribute,
             Sedition
                                                       Yes                                        a controlled substance                  Yes
                                                                                          Conspiracy to commit any of the acts
             Treason
                                                       Yes                                                 listed                         Yes
                                                                                          Possession/Distribution of controlled
               Rape
                                                       Yes                                              substances                        Yes
           Kidnapping                                  Yes
           Harassment                                  Yes



                                            Greater Baton Rouge Industry Alliance Inc. Last Update 9/21/2007
                          5800 One Perkins Place Dr. Suite 5-A | Baton Rouge, LA 70808 | Phone 225-769-0596 | Fax 225-769-0289

                                                                                                                                 Page 7
                  Greater Baton Rouge Industry Alliance
                      Pre-Qualification Add-on Form
 (To be used in conjunction with the Houston Area Safety Council
         and Southwest LA Safety Council PQF Systems)
Security (continued)
Has any employee been denied admission to the United States or been removed from the
United States under sub-clause (IV), (VI), or (VII) of Section 212 (a)(3)(B)(I) of the
Immigrations and Nationality Act (8 U.S.C. 1182 (a)(3)) who:
Is a representative of a foreign terrorist organization, as designated by the Secretary of
State under Section 219?                                                                                              Yes

Is a representative of a political, social, or other similar group whose public endorsement
of terrorist activity the Secretary of State has determined undermines United States
efforts to reduce or eliminate terrorist activities?                                                                  Yes

Has used the alien‟s position of prominence within any country to endorse or espouse
terrorist activity, or to persuade others to support terrorist activity or a terrorist
organization, in a way that the Secretary of State has determined undermines United
States efforts to reduce or eliminate terrorist activities?                                                           Yes

Is the spouse or child of an alien who is inadmissible under this section, if the activity
causing the alien to be found inadmissible occurred within the last 5 years?                                          Yes



Is state issued identification required of all potential employees?                                                   Yes
Are there any other forms of identification used to verify the identity of the applicant?                             Yes
Is each employee checked to determine citizenship status?                                                             Yes
Are motor vehicle records reviewed for each employee who drives company vehicles
and/or operates machinery?                                                                                            Yes
Do you verify employee address and contact information?                                                               Yes
                       If so, how?
Do you maintain a personnel file on each employee?                                                                    Yes
Do you verify previous employment?                                                                                    Yes
                       If so, how far back do you review?
Does your company have badges that readily identify your employees?                                                   Yes
Are company owned movable items marked by a company logo/name (i.e. vehicles, high
dollar tools, trailers, etc.)?                                                                                        Yes




                                           Greater Baton Rouge Industry Alliance Inc. Last Update 9/21/2007
                         5800 One Perkins Place Dr. Suite 5-A | Baton Rouge, LA 70808 | Phone 225-769-0596 | Fax 225-769-0289

                                                                                                                                Page 8
                 Greater Baton Rouge Industry Alliance
                     Pre-Qualification Add-on Form
 (To be used in conjunction with the Houston Area Safety Council
         and Southwest LA Safety Council PQF Systems)
Certified Craftsperson

On average, what percentage of your employees meets the certified
craftsperson definition? (See the definition on the last page)

What is the actual number, by craft, that are considered Certified
Craftpersons?

Concrete Finisher
Industrial Boilermaker
Industrial Carpenter
Industrial Electrician
Industrial Insulator
Industrial Ironworker
Industrial Millwright
Industrial Painter
Industrial Pipefitter
Instrumentation Fitter
Instrumentation Technician
Mobile Crane Operator
Reinforcing Iron & Rebar Worker
Scaffold Builder
Refractory Worker
Lineman
Fiber Optic Technician
Heavy Equipment Operator
Tank Fitter




                                            Greater Baton Rouge Industry Alliance Inc. Last Update 9/21/2007
                          5800 One Perkins Place Dr. Suite 5-A | Baton Rouge, LA 70808 | Phone 225-769-0596 | Fax 225-769-0289

                                                                                                                                 Page 9
                 Greater Baton Rouge Industry Alliance
                     Pre-Qualification Add-on Form
 (To be used in conjunction with the Houston Area Safety Council
         and Southwest LA Safety Council PQF Systems)
Industry, Professional, Community, and Political Involvement
(This section is optional)
Please list the organizations in which your employees are active, i.e. LCIA, ABC,




For any of these organizations, are you or members of your company (check all that apply):

                                                               Other?
     Members?          On a           Officer/Board
                     committee?        Member?


Political Involvement (This section is optional)
List the names of the Political Action Committee you or your organization support financially,
i.e. LAMP, ABC, etc.




List any candidates you or your company have supported and the type of support.

                                                                                                         Financial             Volunteer/Grass Roots
                                                                                                         Financial             Volunteer/Grass Roots

Who are your elected officials? Would you be willing to contact them on behalf of
industry?
                                                                                                                Yes                No
                                                                                                                Yes                No




                                          Greater Baton Rouge Industry Alliance Inc. Last Update 9/21/2007
                        5800 One Perkins Place Dr. Suite 5-A | Baton Rouge, LA 70808 | Phone 225-769-0596 | Fax 225-769-0289

                                                                                                                                  Page 10
   Definition of a Certified Craftsperson in the Greater Baton Rouge Area

The following definition has been agreed upon by the Greater Baton Rouge Industry
Alliance, Inc. and the Associated Builders and Contractors, Pelican Chapter’s Industrial
Contractors Council to provide clear communication between plants/owners and
contractors when planning staffing for industrial maintenance and construction support.

            One who has relevant craft work experience as detailed in Table 1 and has
             been certified by one of the following processes:

            NCCER Certified Plus
                Met cut score on the written assessment in his or her craft
                Successful completion of the performance verification

                                                          OR

            Certification process for welders per section IX of the ASME Code or other
             recognized industry standard

                                                          OR

            Specialty training and/or certification provided by other organizations
             including the employer of the craftsperson, is acceptable when this type of
             training and/or certification is not provided by NCCER (i.e. refractory worker,
             lineman, fiber optic technician, heavy equipment operator, etc.)

                                                       Table 1
                                        Craft                             Relevant Years of
                                                                          Work Experience
                  Concrete Finisher                                              2
                  Industrial Boilermaker                                         4
                  Industrial Carpenter                                           3
                  Industrial Electrician                                         4
                  Industrial Insulator                                           2
                  Industrial Ironworker                                          3
                  Industrial Millwright                                          4
                  Industrial Painter                                             2
                  Industrial Pipe fitter                                         4
                  Instrumentation Fitter                                         4
                  Instrumentation Technician                                     4
                  Mobile Crane Operator                                          3
                  Reinforcing Iron & Rebar Worker                                2
                  Scaffold Builder                                               3
                  Refractory Worker                                              2
                  Lineman                                                        4
                  Fiber Optic Technician                                         4
                  Heavy Equipment Operator                                       3
                  Tank Fitter                                                    2




                             Greater Baton Rouge Industry Alliance Inc. Last Update 9/21/2007
           5800 One Perkins Place Dr. Suite 5-A | Baton Rouge, LA 70808 | Phone 225-769-0596 | Fax 225-769-0289

                                                                                                                  Page 11

				
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