Subs Qual Form

Joplin Construction Design and Management is always on the lookout for well qualified sub-contractors. We are interested in receiving information about your company. In order to pre-qualify your organization please fill out the information below. You can either print this form and fax it to (417)781-4480 or fill in the form and press the "Submit Form" button and it will e-mail us directly.

Name of Company:
PO Address:
Physical Street Address:
City, State, & Zip:
Phone Number:
Fax Number:
Contact Person:
Web-Site:	http://
E-Mail:
1. How many years has your organization been in business as a Contractor?	Years
2. Geographic area of operations:
Are you willing to travel?	(Yes / No)
If yes, which states?
3. Type of work your organization performs?
4. Type of Licensing your organization holds?
5. List of current projects in progress. (Project/ Approximate Value, Contact Person, Phone Number)
6. List significant projects you company has completed in recent years that we may contact for reference. Please include phone number and fax.
7. Credit references:
8. Bank:
9. Number of employees:	Office Field
10. Are you bondable? If yes, give details: Single project limit, aggregate limit, bonding company (Name, Address, Phone, Agent)	(Yes/No)
11. During the past five years, have any liens been filed against you by any of your subcontractors or suppliers? If yes, please explain.	(Yes/No)
12. Have you ever failed to complete a contract, been defaulted, or have a contract terminated? If yes, please explain.	(Yes/No)
13. In the past five years, have you had liquidated damages assessed against you upon completion of a project? If yes, please explain.	(Yes/No)
14. In the past five years, has your company or any of its key people been involved in any lawsuits arising from construction projects? If yes, please explain.	(Yes/No)
15. In the past five years, has your company or any of its key people been investigated for of found to have committed a violation of any labor laws? If yes, please explain.	(Yes/No)
16. Does your company have a formal written safety program?	(Yes/No)
17. Does your company provide OSHA training for all employees?	(Yes/No)
18. Do you routinely comply with all OSHA regulatory requirements?	(Yes/No)
19. In the past five years, has your company or any of its key people been investigated for or found to have committed a serious OSHA violation?	(Yes/No)
20. In the past five years, has your company or any of its key people been investigated for or found to have committed a violation of state, federal, or local environmental protections laws?	(Yes/No)
21. Is there any other information you would like to give us?

(Please review the above information before clicking on the 'Submit Form' button)

The information provided will be held in confidence and used only to evaluate the qualifications of any firm submitting this information as it relates to performing or bidding work on any upcoming projects for Joplin Construction Design & Management.

Thank you for your cooperation.

As mentioned above: you can print this form and fax it to (417) 781-4480 or press the "Submit" button below and automatically e-mail us directly.