SUBCONTRACTORS APPLICATION FORM

Thank you for your interest in Barry Swenson Builder.

In order to develop a more complete knowledge of your Company and better match future BSB opportunities to your Company’s capabilities please complete the form below!

Please FILL OUT THE FORM ENTIRELY to be considered as a contractor!

NOTE: AFTER COMPLETION OF THE FORM BELOW YOU WILL BE REQUESTED TO PROVIDE THE FOLLOWING via e-mail or fax. You will be instrucuted on where to send the following only after completing the form below:

1. List of current major projects giving name of project, address, owner, architect, general contractor, contract amount, scope of work and scheduled completion. (Include contact people and phone numbers)

2. List of completed major projects giving name of project, address, owner, architect, general contractor, contract amount and scope of work. (Include contact people and phone numbers)

3. Copy of your latest audited financial statement.

4. We will provide you with a Safety Pre-qualification Form to complete

5. We will provide you with an Insurance Questionnaire

Subcontractors Application

Name of Company *

Contact Person First Name *

Contact Person Last Name *

Email of Contact Person *

Address *

City *

State *

Zip *

Phone *

Fax *

Is the Main Address: *

Main Office
Regional Office
Branch Office

Is Your Company *

MBE
WBE
DBE

MBE/WBE/DBE Certified by: *

Name of Parent Company: *

Address of Parent Company *

Please Fill in the TRADES your Company is interested in bidding. *

State of Incorporation *

Date of Incorporation *

Contractor's License # *

Contractor's License State *

Contractor's License Expiration Date *

State Sales Tax Registration Number *

State Unemployment Insurance Number *

Federal ID Number *

List the corporate officers, partners, proprietors, members and shareholders of more than 5% of the stock of your Company INCLUDING: Name, Year of Birth, Position & Percent Owned *

Under What other names has your company operated? *

How many People does your company currently Employ? *

How many people did your company employ on average for the last 3 years? *

Has your Company or any of its principals ever petitioned for bankruptcy, failed in business, defaulted or been terminated on a contract awarded to you? If so, please explain.... *

Have any of the Owners, officers or major stockholders of your Company ever been indicted or convicted of any felony
or other criminal conduct?
If Yes, Please explain..... *

Has your Company or any Owners, officers or major stockholders ever been suspended, disbarred or otherwise precluded from pursuing public work or ever been found to be non- responsive by a public agency? If so, please Explain...... *

Has your Company ever had a claim made against it for improper, delayed, defective or non-compliant work or failure to meet warranty obligations? *

Is your Company or any of its owners, officers or major shareholders currently involved in any arbitration or litigation? *

Does you Company have any outstanding judgements or claims against it? *

Has your company or any of its owners, officers or major stock holders been investigated for or charged with alleged labor law violations including alleged violations of the Immigration Control and Reform Act; state or local laws regarding employment of immigrants; prevailing wage laws; wage and hour laws or other federal, state or local labor laws? If yes, please explain. *

Please list any litigation brought against your Company in the past five (5) years asserting that you failed to make
payments to anyone. *

List the geographical areas in which you work : *

List Unions which you have agreements with: *

Indicate the size of project you are most competitive in performing (enter 1): *

$100-$200k
$200-$500k
$500-$1MM
$1-$3MM
$3-$6MM
$6-$9MM
$10-$15MM
Over $15MM

Check all building types on which your Company has worked: *

High Rise Office Building
Mid Rise Office
Hotels/Motels
Hospital
Residential
Sports/Entertainment
Industrial
High Tech / Labs
Correctional Facilities
Design Build/ Design Assist

List the trades you normally perform with your own forces: *

What percentage of the Company’s work is normally subcontracted? *

What trades do you normally subcontract? *

What is the largest contract your Company has completed, including project Amount, Year, Name & Location? *

What is the largest dollar volume job you expect to do during this year including project name and location? *

What is your expected annual volume this year including total number of project and total dollar amount? *

What is your average annual volume over the last 5 years? *

MBE Participation in work which you subcontract (average participation for last 3 years) % *

WBE Participation in work which you subcontract (average participation for last 3 years) % *

Minority workforce participation (average percentage utilization for last 3 years) % *

Female workforce participation (average percentage utilization for last 3 years) % *

Name of your Bank *

Bank's Address *

Bank's Phone # *

Bank Contact Person *

Amount of Line of Credit *

Amount Available: *

Expiration Date of Line of Credit *

UCC Filing? *

YES
NO

How is Credit Secured? *

What is Company’s Dunn & Bradstreet Number: *

D&B Rating: *

Pay Record: *

Date of Rating: *

Bonding Compay: Name of Surety: *

Bonding Company Key Contact Person *

Bonding Company Key Contact Person Phone # *

Bonding Capacity per job: *

Bonding Capacity Aggregate: *

Date of Last Bond & Amount: *

Please list the persons or entities who provide indemnification to your Surety: *

List 3 of your main suppliers including relevant address, phone & contact person information for each: *

List 3 contractors that you do business with including relevant address, phone & contact person information for each: *

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