Subcontractor Qualification Statement

Fill out the form below and a password to the Drawing Room will be emailed to you.

Company Name & Address

Company Name

Company Address

City

State

Zip


Contact Person for Estimates

Name

Title/Position

Email

Office Phone

Mobile Phone

Office Fax


How many years has your company been in business?

What is your average yearly revenue over the past three years?

What is your average project size ($/Project)

What is the dollar value of the largest project successfully completed by your company

Can you provide a bond?
If yes, up to what dollar amount?

Has your company ever failed to complete any work awarded in the past five years?
If yes, please explain

Are there any pending or outstanding claims, arbitrations, or lawsuits against your company?
If yes, please explain

What work categories does your company perform?

Is your company experienced with prevailing wage projects?

Is your company union?
If yes, please list the unions with which your company is affiliated

What is the average size of your field work force?

Does your company qualify with any of the following?

Certified by:


Please provide a representative list of clients you have worked for.

Company
Contact
Contact Phone

Company
Contact
Contact Phone

Company
Contact
Contact Phone


Are you willing to travel for projects outside the Chicago and Chicagoland Market?


Please provide a representative list of projects the work performed and the contract value (if necessary, provide this information as an addendum).

Project
Contract Amount
Project Type
Work Performed

Project
Contract Amount*
Project Type
Work Performed

Project
Contract Amount
Project Type
Work Performed

Project
Contract Amount
Project Type
Work Performed

Project
Contract Amount
Project Type
Work Performed


Safety & Health Performance

Present EMR is

Employee hours worked last year (2012):

State of origin:

Have You received any regulatory (EPA, OSHA,Etc) Citations in the last three years?
If yes, please attach copies using the file upload section at the end of this form


Safety & Health Management

Do you have a written safety and health program?

Do you have a written Hazard Communication Program?

Do your employees read, write and understand English as such that they can perform their job tasks without an interpreter?

Do you have personnel trained to perform CPR & First aid?

Do you have safety and health orientation for new hires and newly hired or promoted supervisors?

Have your employees received required health and safety training and retraining?

Do you hold site safety and health meetings for:

Are Safety and health meeting documented:


Inspections and Audits

Do you conduct safety & health inspections?

Do you conduct safety & health program audits?

Are corrections of deficiencies documented?


Additional Comments

File Upload: Please attach any additional information, qualifications, promotional materials etc. which you feel would be of interest to SYNERGY. Any additional information is NOT required but will be reviewed (PDF, Word Doc, JPG files accepted).

I verify that the information provided above is accurate.

2037 W Carroll Street      Chicago, IL
      
312.243.3700      info@syn-grp.com
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