REQUEST A QUOTE
Please fill the form below:
Company Name*
Area of Expertise*
Email*
Phone*
Address*
Tax ID / SS Number*
Contact Person*
Type of Company*
Date company formed*
Total number of employees*
States in which company is legally qualified to do business (Include type and license numbers)*
Names & Titles of Key Personnel in Company*
Has the company operated under any other name in the past five years?*
If yes, give name(s)?*
Does the company have offices, plants or warehouses at other locations?*
If yes, give location(s)?*
Is the company a Minority Business Enterprise (MBE), Women Business Enterprise (WBE), Small Business Enterprise (SBE) or any other type of certified business enterprise?*
If yes, what type?*
Does the company have a line of credit from any lending institution?*
If yes, please provide details:*
Lender's name, Address, Officer's name, Phone:*
Do you have the ability to bond projects?*
If yes, date of last bonded project:*
Single project limit*
Aggregate Limit*
Bonding Company Name, Address:*
In the past 5 years, has your company or any of its key personnel been investigated for or found to have committed a serious OSHA violation?*
If yes, provide details:*
What is your current Workman's Compensation EMR rate? Please attach a copy of current EMR at end of form*
Do you have written employee safety policy & program?*
Are there any open or aggregate liability claims that would impair your ability to insure a project?*
If yes, give date:*
If yes, give details*
If yes, give dates and details*
Current projects Include name of project, scope of work, contract amount and completion date*
Trade References Include name of project, scope of work, contract amount and completion date*
Client References List 3 clients, include names and phone numbers*
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