Subcontractor Prequalification Form

Thank you for taking the time to complete Nordby Construction's Subcontractor Prequalification Form. As this is a web accessed form and cannot be saved, we recommend that you scroll through each tab before you begin to ensure you have all the necessary information required. In addition, under tab 3 you will be asked to confirm acceptance of Nordby's Standard Contract. As this is a few pages long, we suggest you carefully review the document prior to starting the form process.

We thank you again for your time and effort and look forward to a long term and fruitful relationship.

Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7

* RequiredA. TELL US ABOUT YOUR COMPANY:
*NAME OF COMPANY:	Joe's Construction
*STREET ADDRESS:	123 Steet St.
*CITY, ST ZIP:	, Auburn, CA 95602
*MAILING ADDRESS:	123 Steet St.
*CITY, ST ZIP:	, Auburn, CA 95602
*PHONE NUMBER:	(555) 555-5555
FAX NUMBER:	(555) 555-5555
*CONTACT'S NAME:	Joe Blow
DIRECT LINE, EXT	, (555) 555-5555, #123
CELL NUMBER:	(555) 555-5555
*EMAIL:	joe@joesconstruction.com
WEBSITE:	www.JoesConstruction.com
EMAIL CONTACT FOR BID NOTIFICATIONS:	joe@joesconstruction.com

B. TELL US ABOUT THE TYPES OF WORK YOUR COMPANY PERFORMS AND LOCATION:
1. CHECK BELOW THE TYPE(S) OF WORK YOUR COMPANY HAS STRONG EXPERIENCE IN PERFORMING. PLEASE CHECK ALL THAT APPLY: Scaffolding Survey Demolition Earthwork Paving Site Concrete Landscaping Concrete Masonry Stone Structural Steel Rough Carpentry Finish Carpentry Architectural Woodwork Waterproofing Insulation Roofing Doors & Windows Glazing Drywall Tile Flooring Carpet Painting Toilet, Bath, Laundry Acc. Food Service Equipment Swimming Pools Solar Energy Systems Plumbing Fire Sprinklers HVAC Electrical Other:
2. WHAT SIZE ($ RANGE) OF CONTRACT SCOPE BEST FITS YOUR COMPANY'S SIZE AND CAPABILITY?
$: To $:
3. IN WHICH GEOGRAPHICAL AREA(S) DO YOU PERFORM THE MAJORITY OF YOUR WORK? PLEASE CHECK THE TOP 3-5: SONOMA COUNTY NAPA COUNTY LAKE COUNTY MENDOCINO COUNTY MARIN COUNTY EAST BAY SACRAMENTO AREA CENTRAL CALIFORNIA PENINSULA SF/OAKLAND AREA SOUTHERN CALIFORNIA INLAND EMPIRE RIVERSIDE COUNTY ORANGE COUNTY LOS ANGELES AREA OTHER

C. STANDARD SUBCONTRACT AGREEMENT:
Nordby Construction only accepts subcontractors who have accepted our Standard Subcontract Agreement. Please review this document and indicate below if you are willing to sign Nordby Construction's Subcontractor Agreement, including the brief statement specifying agreement with all the terms, conditions, and provisions included in the Subcontract Agreement. Standard Subcontract Agreement (20 pgs)
I HAVE READ NORDBY CONSTRUCTION'S LONG FORM STANDARD SUBCONTRACTOR AGREEMENT AND UNDERSTAND AND AGREE WITH THE PROVISIONS CONTAINED THEREIN. Yes No
IF NO, PLEASE STATE SPECIFIC EXAMPLES AS TO WHY:

D. HOW IS YOUR COMPANY ORGANIZED?
1. CORPORATION PARTNERSHIP SOLE PROPRIETOR
2. YEAR FOUNDED:
3. HOW LONG HAS PRESENT MANAGEMENT CONTROLLED THE FIRM?
4. WHAT WAS YOUR ANNUAL DOLLAR VOLUME FOR THE PAST THREE (3) YEARS?
LAST FULL YEAR ($):
1 YEAR PRIOR ($):
2 YEARS PRIOR ($):
5. WHAT ARE THE NAMES AND TITLES OF YOUR CURRENT PRINCIPALS AND OFFICERS?
NAME, TITLE	,
NAME, TITLE	,
6. NUMBER OF FIELD AND ADMINISTRATIVE EMPLOYEES?
FIELD:
ADMIN:

E. LABOR AFFILIATIONS:
1. MERIT SHOP UNION
2. WHAT LICENSE(S) DO YOU HAVE?
None
LICENSE NUMBER	STATE	LICENSE CLASSIFICATION



3. COMMERCIAL GENERAL LIABILITY INSURANCE POLICY:
A. CAN YOUR COMPANY PROVIDE THE FOLLOWING:
$1,000,000 PER OCCURANCE: Yes No
$2,000,000 AGGREGATE: Yes No
CG 20 10 11 85 OR EQUIVELENT COMPLETED OPERATIONS POLICY Yes No
B. DOES YOUR COMPANY CARRY AN UMBRELLA POLICY? Yes No
C. IS YOUR COMPANY BONDABLE? Yes No
BONDING LIMIT:		($) Max

F. WHAT IS YOUR SAFETY RECORD?
1. DO YOU HAVE A SAFETY PROGRAM? Yes No
2. DO YOU HAVE A WRITTEN DRUG POLICY? Yes No
3. DO YOU HAVE A FULL TIME SAFETY MANAGER OR EMPLOY THE SERVICES OF A SAFETY CONSULTANT? Yes No
4. DO YOU HAVE OSHA 300 LOGS FOR THE PAST YEAR? Yes No
5. HAVE YOU BEEN CITED BY OSHA IN THE PAST YEAR? Yes No
IF YES, PLEASE EXPLAIN BELOW:
6. WHAT IS YOUR FIRM'S WORKER'S COMPENSATION EXPERIENCE MODIFICATION RATE (EMR) FOR THE PAST THREE (3) YEARS?
CURRENT:
YEAR PRIOR:
2 YEARS PRIOR:

G. OTHER REQUESTED INFORMATION FOR BIDDING:
1. DO YOU HAVE DESIGN BUILD CAPABILITIES OR AN IN-HOUSE ENGINEERING STAFF? Yes No
2. DO YOU HAVE EXPERIENCE WITH LEED CERTIFIED PROJECTS? Yes No
IF YES, LIST PROJECT NAMES AND LEVELS OF CERTIFICATION ACHIEVED:
PROJECT NAME & LOCATION	LEVEL OF LEED CERTIFICATION



3. NUMBER OF LEED ACCREDITED STAFF MEMBERS:
4. NORDBY CONSTRUCTION DOES THE MAJORITY OF BID WORK USING AN FTP SITE FOR INFORMATION DISTRIBUTION. ARE YOU ABLE TO OBTAIN THE REQUIRED INFORMATION FROM A FTP SITE TO BID A PROJECT? Yes No