Subcontractor Pre-Qualification Statement

Project Name: *
Contact at Joe Funk Construction Engineers (if applicable):
SUBCONTRACTOR PRE-QUALIFICATION STATEMENT
Overview: it is the policy of Joe Funk Construction Engineers, Inc. to pre-qualify our subcontractors prior to bidding on any of our projects. Your pre-qualification status must be updated annually.
Questions can be directed to Phillip Adlof, Chief Estimator, at (972)406-5208 or E-Mail to padlof@joefunkconstruction.com
Please complete as it appears on your State Contractor's License:
Legal Name of Firm: *
DBA: *
Address: *
State: *
City: *
ZIP: *
Year of Organization:
#1 State:
#1 Class(es):
#1 Expiration
#2 State:
#2 Class(es):
#2 Expiration:
#3 State:
#3 Class(es):
#3 Expiration:
#4 State:
#4 Class(es):
#4 Expiration:
Please enter your mailing address below
Mailing Address: *
State: *
City *
ZIP: *
Web Address:
Provide names and titles of your firm's contacts:
PRINCIPAL CONTACT
Title:
Phone:
Fax:
E-mail:
ESTIMATING CONTACT:
TITLE:
Phone:
Fax:
E-mail:
Your Company's Minority Status:
Please check all that may apply and provide proof of certifications:
Your Company's Minority Status:	NCTRCA DBE Disadvantaged Business Enterprise DVBE Disabled Veterans Business Enterprise MBE Minority Business Enterprise SBE Small Business Enterprise WBE Women Business Enterprise HUB Historically Underutilized Business WOSB Women Owned Small Business
Year of 2008:
Annual Sales:
Largest Single Contract Value:
General Contractor
Year of 2007
Annual Sales:
Largest Single Contract Value:
General Contractor
Year of 2006
Annual Sales:
Largest Single Contract Value:
General Contractor
Safety: List Experience Modification Rate:
2008:
2007:
2006:
Federal Tax ID:
Dunn & Bradstreet Number:
Current Bonding and Banking Information:
Surety Company:
Broker:
Contact Person:
Phone:
Name of your bank:
Address:
Contact Person:
Phone:
References:
List three major suppliers:
Reference # 1 Company Name:
Reference # 1 Address:
Reference # 1 State:
Reference # 1 City:
Reference # 1 Phone:
Reference # 1 Fax:
Reference # 1 Contact:
Reference # 2
Reference #2 Company name:
Reference #2 Address:
Reference #2 State:
Reference #2 City:
Reference #2 Phone:
Reference #2 Fax:
Reference #2 Contact:
Reference # 3
Reference # 3 Company name:
Reference # 3 Address:
Reference # 3 State:
Reference # 3 City:
Reference # 3 Phone:
Reference # 3 Fax:
Reference # 3 Contact:
List three General Contractors:
General Contractor # 1 Company Name:
General Contractor # 1 Address:
General Contractor # 1 State:
General Contractor # 1 City:
General Contractor # 1 Phone:
General Contractor # 1 Fax:
General Contractor # 1 Contact:
General Contractor # 2
General Contractor # 2 Company Name:
General Contractor # 2 Address:
General Contractor # 2 State:
General Contractor # 2 City:
General Contractor # 2 Phone:
General Contractor # 2 Fax:
General Contractor # 2 Contact:
General Contractor # 3
General Contractor # 3 Company Name:
General Contractor # 3 Address:
General Contractor # 3 State:
General Contractor # 3 City:
General Contractor # 3 Phone:
General Contractor # 3 Fax:
Contact:
IN ORDER TO BE PREQUALIFIED FOR A $100,000 OR LARGER SUBCONTRACT, THE FOLLOWING MUST BE PROVIDED ANNUALLY:
A letter from your surety outlining the single project and aggregate amounts for which they will issue a performance and payment bond.
Please be assured your financial information will be kept confidential in accordance with our Subcontractor Privacy Statement.
Your pre-qualification status cannot be determined until the pre-qualification statement is accurately completed, a letter from your surety is received.
Completed by: *
Title: *
Date: *
All information given herein, will be considered privileged and confidential and the use of the information shall be limited for the purpose of qualifying your company as a subcontractor or supplier of Joe Funk Construction Engineers, Inc. only ; any other use is prohibited.
Please enter the trade(s) that your company is interested in bidding) (select a number from the list, separate with commas) *	VIEW THE CSI DIVISIONS / TRADES LIST
Enter any other questions/comments: