GENERAL INFORMATION
Company Name:
Address:
City:
State: AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming
Zip Code:
CONTACT INFORMATION
Primary Contact:
Title:
Email:
Phone:
Cell:
Fax:
Estimating Contact:
Other Contact:
COMPANY
Type of Entity: PartnershipSole ProprietorshipCorporationLLC
Other:
Year established under current name:
Is company MBE, WBE, DBE or SBE certified? yesno
Workers’ Compensation Experience Modification Rate:     Current Year:    Previous Year:
Does company have a written safety program?yesno
Is company able to provide a P&P bond if required? yesno
Average annual sales over past three years
Average project size:    Value:    Sq. Ft.
List three projects representative of your company completed in the last five years:
Name of Project:
Contract Value:
Primary/General Contractor:
Contact:
SCOPE OF WORK/TRADES (Check All that apply)
Geotechnical & Materials TestingInsulationFinal CleaningEIFS/StuccoDemolitionDoors/Frames/Hardware SupplySoil TreatmentDoors/Frames/Hardware InstallationSite DevelopmentStorefront/GlazingSite UtilitiesWindowsErosion ControlDrywall/Acoustical CeilingAsphalt PavingFlooringCurb & GutterPainting – needs to be added nextStriping & SealcoatingSpecialtiesFencingToilet Partitions & AccessoriesRetaining WallsEquipmentLandscapingFurnishingsCast-In-Place ConcreteCaseworkStructural PrecastCountertopsMasonryPoolsCultured StoneMetal Building SystemsStructural SteelElevatorsMetal FabricationsFire ProtectionRough CarpentryPlumbingFinish/Trim CarpentryHVACArchitectural Millwork/Casework SupplyElectricalCaulking/WaterproofingFire Alarm / SecurityRoofingLow VoltageMetal RoofingOther
GEOGRAPHIC AREA SERVED (Check all that apply)
Metro AtlantaNorth GeorgiaCentral GeorgiaSouth GeorgiaAlabamaFloridaNorth CarolinaSouth CarolinaOther
MARKET SECTORS SERVED (Check all that apply)
AviationGovernmentHealthcareHospitalityIndustrialInteriorsOfficeRetailOther