Subcontractor Pre-Qualification Form

Person Completing Form(Required)

First Last

Structure of Company

List of states/metro areas in which authorized to do work (please include license # if applicable):(Required)

Contractor parent company (company name / president / address / phone)(Required)

# of Employees (office and field)(Required)

Company Profile

Type of Company:(Required)

Subcontractor (Furnish & Install)

Subcontractor (Install Only)

Supplier (Materials Only)

Trade/Type of work performed(Required)

Project Size:(Required)

$250,000 or below

$251,000– $499,000

$500,000 – $999,999

$1,000,000 or more

Types of Projects(Required)

Other Types of Projects

Geographic Work Areas(Required)

List Other States/Areas

Do you have experience with EarthCraft?(Required)

Yes

Do you have experience with VHDA?(Required)

Yes

How many years have you been in business?(Required)

Please attach workers comp and general liability insurance certificates

Please attach copy of previous year’s OSHA 300 form(Required)

Max. file size: 256 MB.

Work in Progress

Amount of work under contract:

Amount of that work not yet completed:

Please complete requested information on company’s recent major construction projects either completed or in progress

Name of Project	Client/Owner	Actions

There are no Projects.

References

Trade References

Name	Phone	Actions

There are no References.

Please list three supply company references with whom you have accounts with to purchase materials.

General Contracting References

Name	Phone	Actions

There are no References.

Please list three general contractors or develpers with whom you have worked for in the last year.

Signature(Required)