Sub Contractor Form
Sub-Contractor Form
Sub-Contractor Form
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Step
1
of 5
General Company Information
Has your company submitted a bid to JDC within the last 30 days?
Yes
No
Company's Legal Name
Mailing Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Street Address (If different from mailing address.)
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
Fax Number
Email Address
Company Website
Estimating Contact
Title
Year Company was Founded
Type of Company
C Corporation
S Corporation
Partnership
Sole Proprietor
Other
Other type of Company
Are there any affiliated subsidiaries?
Yes
No
Is your firm owned or controlled by another organization?
Yes
No
If yes, please enter name of parent organization.
State Sales Tax Registration Number
State Unemployment Insurance Number
Union
Yes
No
Total number of current employees.
Number of Office Personnel
Number of Field Supervisors
Minority Business Enterprise Status
MBE
WBE
DBE
SBE
Please upload certifications regarding your MBE status.
Click or drag a file to this area to upload.
Preferred Project Size
$10K - $250K
$251K - $500K
$1M
$2M
$5M+
List the geographical areas in which you work:
List the trades you normally perform with your own forces:
What percentage of the company's work is normally subcontracted?
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Contractor's License(s) States and Numbers
State:
License Number:
State:
License Number:
State:
License Number:
State:
License Number:
Company's Principals
Name:
Title:
Name:
Title:
Name:
Title:
Name:
Title:
Name:
Title:
Surety Information
Current Surety Company
Broker Agent Name
Broker Phone
Bond Rates (Please enter bond rates for...)
$100,000
$500,000
$1 Million
$2 Million
$5 Million
Single Project Bonding Capacity:
Aggregate Bonding Capacity
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Safety Information
Company Safety Professional
Title
Phone
Email
Total number of full-time employees.
Total number of part-time employees.
Osha 300 Information (Entire Company)
OSHA Recordable Incident Rate
Current Year
Last Year
Year Before Last
Lost Time Incident Rate
Current Year
Last Year
Year Before Last
Number of Recordable Injury Cases
Current Year
Last Year
Year Before Last
Number of Lost Time Incidents/Illnesses
Current Year
Last Year
Year Before Last
Number of Days Away from Work
Current Year
Last Year
Year Before Last
Number of Fatalities
Current Year
Last Year
Year Before Last
Total Employee Hours Worked
Current Year
Last Year
Year Before Last
*** Note: For A&B use the formula: Incidents multiplied by 200,000 then divided by # of Employee Hours Worked.
Experience Modification Rate (EMR)
List corporate Worker’s Compensation Experience Modification Rate or the most recent 3 years and include rating worksheets (i.e. NCCI).
Current Year
Last Year
Year Before Last
OSHA Citations
Has your company received any OSHA citations in the last 3 years?
Yes
No
If yes, please provide: the date of violation, the violation type (i.e. serious), and what has been done to prevent similar violations.
Safety Goals and Objectives
Do you have corporate safety goals and objectives?
Yes
No
Do you have a written safety and health program/manual?
Yes
No
File Upload
Click or drag a file to this area to upload.
Safety Meetings
Do your supervisors hold safety meetings?
Yes
No
If yes, how often do you hold safety meetings?
Do you conduct field safety inspections to determine compliance with applicable federal, state, local and company regulations/procedures?*
Yes
No
If yes, who conducts the inspection?
Are Inspection reports generated?*
Yes
No
If yes, who receives copies of the report?
Do you have a follow-up system to track items identified during safety inspections?
Yes
No
Safety Training and Orientation
Do you have a documented pre-job or new employee occupational safety & health orientation program?
Yes
No
Do you have a documented occupational safety & health training program for newly hired or promoted first line supervisors or foremen?
Yes
No
If yes, who conducts training (name, title)?
Please check all elements below that are delivered by your training program:
Injury/Incident/Near-Miss
Emergency Procedures
First Aid Procedures
Hazard Recognition
Incident Reporting
Job Hazard Analysis
Respiratory Protection
Safety Tailgates
Other-Specify
Does your company hold regularly scheduled safety meetings for employees?
Yes
No
If yes, how often?
Drug Free Workplace
Does your company have a Drug Free Workplace Program?
Yes
No
If yes, does this program include the following testing?
Pre-Employment
Random
Post Incident
Reasonable Suspicion
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Litigation Information
Any active litigation with Owners/ General Contractors?
Yes
No
If yes, please explain.
Has your company ever been assessed liquidated damages?
Yes
No
If yes, please explain.
Any labor law violations?
Yes
No
If yes, please explain.
Have you ever defaulted or failed to complete a contract?
Yes
No
If yes, please explain.
Have you ever been terminated from a contract?
Yes
No
If yes, please explain.
Have you ever had your license revoked or suspended?
Yes
No
If yes, please explain.
Scopes of Work Performed
Please list previous scopes of work performed.
Please upload a list of 5 significant projects within the last 3 years to include volume, scope of work and contract amount and your project list for the last 12 months.
Click or drag a file to this area to upload.
Insurance Information
Upload Copy of Insurance Certificate
Click or drag a file to this area to upload.
Insurance Broker Name
Please review the attached sample Certificate of Insurance and Additional Insured Endorsement to verify whether or not you meet the JDC Contractors, Inc. insurance requirements.
We have reviewed the attached documents and we fully meet the J Davis Construction, Inc. insurance requirements.
Yes
No
Please indicate from the list below which J Davis Construction, Inc. insurance requirements you do NOT meet:
CGL Limits of $2M per Project Aggregate
$1M Umbrella / Excess Policy
Business Auto Policy Limits $1M CSL
30 Days Notice of Cancellation
Evidence of Worker’s Compensation
Additional Insured Endorsement
Other
Other:
Additional Information
Please provide additional information or documentation that you feel would be important for us to review during our prequalification process:
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Customer References
Please list three (3) customer references.
Company Name
Contact Name
Title/Position
Phone Number
Email
Company Name
Contact Name
Title/Position
Phone Number
Email
Company Name
Contact Name
Title/Position
Phone Number
Email
Credit References
Please list three (3) credit references.
Company Name
Contact Name
Title/Position
Phone Number
Email
Company Name
Contact Name
Title/Position
Phone Number
Email
Company Name
Contact Name
Title/Position
Phone Number
Email
Key Financial Information
Current Year Revenues
Total Assets
Current Assets
Current Liabilities
Total Liabilities
Net Equity
Current Backlog
Average Monthly Billings
Has your firm filed Bankruptcy?
Yes
No
If yes, please explain.
Do you have a D&B number?
Yes
No
If yes, please list your number.
D&B Pay Index
Person Authorized to Sign on Behalf of the Organization
Name
Title
Digital Signature
First
Last
Date / Time
Website
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