CONFIDENTIAL
SUBCONTRACTOR / VENDOR PRE-REGISTRATION QUESTIONNAIRE
All subcontractors are required to complete this questionnaire.  The contents of this questionnaire will be
considered confidential and used solely to determine your firm's qualifications.
 
 
Thank you for your interest.  In order to evaluate your firm and provide us with current information, please complete the Confidential Pre-Registration Questionnaire. 
 
Upon receipt of your Questionnaire, we will evaluate the information for inclusion on our Subcontractor / Vendor List. 
 
We have elected not to require your company financial statements as a prerequisite to becoming a Pre-Registered Bidder. Financial Statement shall however be required prior to contract award should your firm be determined to be the lowest qualified bidder.
 
We reserve the right to accept or decline any bids.
 
We thank you in advance for the information requested, and look forward to a relationship with your company on future projects.

All fields are required and must be completed before this form can be submitted. Enter N/A or 0 if field is not applicable.  DO NOT leave questions blank. DO NOT use ALL CAPS!

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General Company Contact Information

Legal Name Of Business:

 
Street Address:  
City:  
State:  
Zip Code:
Telephone Number:     EX: 123-456-7890
Fax Number:   EX: 123-456-7890
Main Contact Person:  
Main Contact Email Address:    
Estimator Contact Name:  
Federal Employer Identification Number:    
Type Of Firm:  
Date Founded: EX: 01/01/2007
State Of Formation:  
License Number:  
Experience Modification Ratio:  

 

All fields are required and must be completed before this form can be submitted. Enter N/A or 0 if field is not applicable.  Do not leave questions blank! Do not use ALL CAPS!

Names, Titles, and Length in Position of Principals and Key Officers
Name:  
Title:  
Time in Position (years):  
Name:  
Title:  
Time in Position (years):  
Name:  
Title:  
Time in Position (years):   Enter 0 if there is no person.
 
 
All fields are required and must be completed before this form can be submitted. Enter N/A or 0 if field is not applicable.  Do not leave questions blank! Do not use ALL CAPS!
 
Firm Business Type & Size
Current Number Of Office Employees:  
Current Number Of Field Employees:  
Current Number Of Shop Employees:  
Is your Firm a Union Shop?  
Is your Firm a Merit Shop?   
Minority Small Business Certifications:  
Is Your Firm Owned Or Controlled By Any Other Organization?   
Please describe.   
 
 
All fields are required and must be completed before this form can be submitted. Enter N/A or 0 if field is not applicable.  Do not leave questions blank! Do not use ALL CAPS!
 
Company Bonding Requirements
Can your firm provide a Performance & Payment Bond?   
Name Of Bonding Company  
AM Best Rating This information can be obtained from your Bonding Company.
Financial Size Category This information can be obtained from your Bonding Company.
Single Project Limit: $ EX: 1,000,000
Aggregate Limit: $ EX: 1,000,000
Current Bonded Backlog: $ EX: 1,000,000
 
 
All fields are required and must be completed before this form can be submitted. Enter N/A or 0 if field is not applicable.  Do not leave questions blank! Do not use ALL CAPS!

Below is a list of the minimum insurance requirements for all projects.  Please check “Yes” if you can meet these minimum requirements.  If your insurance amounts differ from these minimums please use the “Other” column to enter your insurance amounts.

 

Minimum Insurance Requirements
Auto Liability $1,000,000 Combined Single Limit Yes  Other $ EX:2,000,000
  $1,000,000 Hired and Non Owned Auto Yes  Other $ EX:2,000,000
General Liability $1,000,000 Each Occurrence Yes  Other $ EX:2,000,000
  $1,000,000 Personal and Advertising Injury Yes  Other $ EX:2,000,000
  $1,000,000 General Aggregate Yes  Other $ EX:2,000,000
  $1,000,000 Products - Completed Operations Aggregate Yes  Other $ EX:2,000,000
  $10,000 Medical Payments Yes  Other $ EX:2,000,000
  Equal to Subcontract Agreement Umbrella Yes  Other $ EX:2,000,000
  Contractual Liability must be included on all General Liability Policies. Yes  
  XCU Liability (Explosion, Collapse, Underground Liability) is included in General Liability Policy Yes  
  WG Mills will be listed as Additional Insured Yes  
Worker's Compensation $100,000 Each Accident Yes  Other $ EX:2,000,000
  $100,000 Each Employee Yes  Other $ EX:2,000,000
  $500,000 Policy Limit Yes  Other $ EX:2,000,000

 

All fields are required and must be completed before this form can be submitted. Enter N/A or 0 if field is not applicable.  Do not leave questions blank! Do not use ALL CAPS!

Company Background Information
Has your firm ever done business under a previous name or DBA?  
  Please describe.   
Has your company or any of the Principals of your company ever been involved in Bankruptcy or Reorganization of a firm?  
Please describe.  
Are there any judgments, claims, arbitrations, proceedings or suits pending/outstanding against your firm or its officers or principals?  

 

All fields are required and must be completed before this form can be submitted. Enter N/A or 0 if field is not applicable.  Do not leave questions blank! Do not use ALL CAPS!

Areas, Disciplines, & Types of Work
 
Be Specific - This information is used in selecting potential bidders.
Please list the type(s) of work you are interested in bidding.     
Educational
Medical
Multi-Family
Municipal
Commercial/Retail
Single Family
Type of Work Performed

 

  
Type of Work Performed (Select N/A if Not Applicable)

 

  
Type of Work Performed (Select N/A if Not Applicable)

 

  
Select from our offices the geographical locations that your firm is willing to work. 
     
Sarasota/Bradenton, Florida Office
Fort Myers, Florida  Office
Jupiter, Florida Office
Clearwater, Florida Office
Orlando, Florida Office
Jacksonville, Florida Office
North Carolina Office    
     
Does your firm subcontract any portion of its work?  
What percentage of scope does it subcontract?   %
 
 
All fields are required and must be completed before this form can be submitted. Sub-Contract Amount must be completed for preregistration approval of listed work experience! 0 is not a acceptable value!  Enter N/A or 0 if field is not applicable.  Do not leave questions blank! Do not use ALL CAPS!

CURRENT WORK EXPERIENCE

 

General Contractor

  
Project Name
 Location Owner 
Company Name
Contact Person
Phone 
EX:123-456-7890
Sub-Contract Amount 
EX: 1,000,000
Must be completed for approval.
 Current Percent Complete
Scheduled Completion Date
EX: 01/01/2007
 Bonded

Y/N
        $ %
        $ %  
        $ %  

All fields are required and must be completed before this form can be submitted. Sub-Contract Amount must be completed for preregistration approval of listed work experience! 0 is not a acceptable value!  Enter N/A or 0 if field is not applicable.  Do not leave questions blank! Do not use ALL CAPS!

WORK EXPERIENCE - LARGEST 3 PROJECTS COMPLETED IN THE PAST 3 YEARS

 

General Contractor

  
Project Name
 Location Owner 
Company Name
Contact Person
Phone 
EX:123-456-7890
Sub-Contract Amount 
EX: 1,000,000
Must be completed for approval.
 Current Percent Complete
Scheduled Completion Date
EX: 01/01/2007
 Bonded

Y/N
        $ %
        $ %  
        $ %  

ANNUAL REVENUE (PAST 3 YEARS)

Year

Do not modify year fields

 Total Revenue

EX: 1,000,000

  
 
 
 
$
 
 
$
 
 
$
 


CONTRACTOR/CM REFERENCES

Company Name (Contact) Telephone

EX: 123-456-7890

 Fax

EX: 123-456-7890

 E-mail