COMPANY INFORMATION

Company Name:
Postal Address:
Physical Address:
Branch Office Locations:
Primary Contact:
Primary Contact Email:
Phone:
Fax:
Company Type: Corporation Partnership Sole Proprietor Other
Targeted Work:
Projects:
Ideal Project Type:
Ideal Dollar Value:

ORGANIZATION

Number of years your organization been in business:
Number of years your organization been in business under its present name:
Under what other or former names has your organization operated?:
Number of Employees:
Number of Work Crews:

LICENSING

List jurisdictions and trade categories in which your organization is legally qualified to do business, and indicate license numbers for each:
Federal Identification Number:

SWAM CERTIFICATION

What is your organization's minority status? MBE WBE SBE DBE Not applicable Other
Certification Status
(Please provide a copy of certification.):		 Private Public Self Not applicable
City:
County:
State:

EXPERIENCE

List the categories of work that your organization normally performs with its own forces:
List the major construction projects your organization has completed within the past five years, giving the name of the project, owner, architect and contract amount.
List the construction experience and present commitments of the key individuals of your organization.
Indicate average contract value for current year:
Indicate range of contract value for current year:
Indicate average annual volume over the last five years:
Indicate range of contract value for the past five years:

CLAIMS AND SUITS

(If the answer is "yes" to any of the following questions, please attach details.)
Has your organization ever failed to complete any work awarded to it? Yes No
Are there any judgments, claims, arbitration proceedings or suits pending or outstanding against your organization or its officers? Yes No
Has your organization filed any lawsuits or requested arbitration with regard to construction contracts within the last five years? Yes No
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? Yes No
Within the last five years, has your organization received any judgments, claims, arbitration proceedings or suits from second tier subcontractors for lack of payment? Yes No

REFERENCES

General Contractor References (list three):
1. Company Name:
    Contact Person:
    Phone:
2. Company Name:
    Contact Person:
    Phone:
3. Company Name:
    Contact Person:
    Phone:

Supplier References (list three):
1. Company Name:
    Contact Person:
    Phone:
2. Company Name:
    Contact Person:
    Phone:
3. Company Name:
    Contact Person:
    Phone:

BONDING

Is your organization bondable? Yes No
Bonding Capacity:
Name of Bonding Company:
Contact Person:
Phone:
If not bondable, please explain:

INSURANCE

Is your organization insured? Yes No
Name of insurance company:
Contact Person:
Phone:

KBS requires all subcontractors to meet the following insurance limits:
Commercial General Liability $1,000,000 - Each Occurrence
$2,000,000 - Annual Aggregate
Automobile Liability $1,000,000 - Each Accident
Commercial Umbrella $5,000,000
Workers Compensation $100,000 - Each Accident For Bodily Injury By Accident
$100,000 - Each Employee For Injury By Disease
Professional Liability $1,000,000 - Per Claim

Is your firm capable of meeting the limits listed above?		 Yes No

FINANCIAL

Indicate your organization's projected revenue for the current year:
Indicate your organization's revenue for the previous year:
Indicate your organization's current backlog of work:
Indicate your organization's current net worth:
Indicate your organization's current credit limit:
Indicate your the percent in use of your organization's current credit limit:

SAFETY

Does your organization employ a safety coordinator? Yes No
Contact Person:
Phone:
Does your organization require safety training for employees? Yes No
Indicate your organization's Experience Modification Rate for each of the last five years:

ACKNOWLEDGEMENT

The undersigned certifies the information provided herein is true and sufficiently complete so as not to be misleading.
Contact Name:
Title:
Date Completed: