Subcontractor Pre-Qualification

1. Company Overview

Legal Business Name

DBA (if applicable)

Business Structure

Headquarters Address

Phone Number

Website

Primary Contact Person

Title

Contact Email

Direct Mobile

Date Established

State of Inc

Federal Tax ID (EIN)

Number of Employees

2. Core Capabilities & Experience

Primary Trades / Areas of Expertise

Geographic Work Areas (States / Counties)

Average Project Size ($)

Max Project Capacity ($)

Years of Experience in Current Trade

List 3 recent projects completed

Project 1 - Name / Value

Project 1 - Contact

Project 2 - Name / Value

Project 2 - Contact

Project 3 - Name / Value

Project 3 - Contact

3. Licensing, Insurance & Bonding

Contractor License Number(s)

State

Expiration

Can you provide a 100% Performance & Payment Bond?

YesNo

Bonding Capacity per Project ($)

Aggregate ($)

Bonding Company / Agent

Insurance Carrier Details

General Liability Limits

GL Expiration Date

Workers Compensation Limits

WC Expiration Date

Automobile / Umbrella Limits

Auto / Umbrella Expiration Date

4. Safety & Health Performance

Experience Modification Rate (EMR) for the past 3 years

2025 EMR

2024 EMR

2023 EMR

Has your company received any OSHA violations in the last 3 years?

YesNo

If yes, explanation and corrective action taken

Do you have a written Corporate Safety Program?

YesNo

Your current TRIR

5. Financials

Annual Gross Revenue (Past 3 Years)

2025 Revenue ($)

2024 Revenue ($)

2023 Revenue ($)

Bank Reference Name

Bank Contact

Has your company or any principal ever filed for bankruptcy?

YesNo

Is your company currently involved in any active litigation or claims?

YesNo

Required Attachments Checklist

Please confirm each item you are prepared to submit. Documents can be emailed after form submission.

Doc-Contractor-LicensesCopy of current state Contractor LicensesDoc-COICertificate of Insurance (COI) naming J. W. Grand, LLC as additional insuredDoc-Bonding-LetterLetter from Bonding Company stating current capacityDoc-W9W-9 Form signed and dated within the current calendar yearDoc-OSHA-LogsOSHA 300 / 300A Logs from the last 3 years

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Join our subcontractor network

Pre-Qualification Form

1. Company Overview

2. Core Capabilities & Experience

3. Licensing, Insurance & Bonding

4. Safety & Health Performance

5. Financials

Required Attachments Checklist

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