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About Us
Our Story
Our Team
Our Projects
Services
Services Overview
Delivery Overview
Resources
Careers
Affiliations
Subcontractors and Vendors
Contact us
Client FTP
Subcontractors and Vendors
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Subcontractors and Vendors
Subcontractors and Vendors
Pellicano Construction requests that all subcontractors and vendors complete the qualification form:
GENERAL INFORMATION
Select One of the Following
*
SOLE PROPREITORSHIP
PARTNERSHIP
CORPORATION
SUB-S CORP.
NAME OF FIRM
*
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
YEAR FIRM BEGAN OPERATION
TOLL FREE NUMBER
Corporate Officers- Partners-Proprietorship
NAME
AGE
POSITION
YEARS W/ FIRM IN THIS POSITION
% OF OWNERSHIP
Please enter a number from
0
to
100
.
NAME
AGE
POSITION
YEARS W/ FIRM IN THIS POSITION
% OF OWNERSHIP
Please enter a number from
0
to
100
.
NAME
AGE
POSITION
YEARS W/ FIRM IN THIS POSITION
% OF OWNERSHIP
Please enter a number from
0
to
100
.
Type of work your firm specializes in:
List the geographic areas (States) where your firm is licensed to do business:
Estimating Contact:
Name
Email
Phone
President or Local Manager:
Name
Email
Phone
Does your organization have in-house design/engineering capabilities?
Yes
No
If so, does your firm carry professional Liability (errors & omissions) Insurance?
Yes
No
Would you be willing to provide current financial statements when requested?
Yes
No
DIVERSITY
Certified Minority Business Enterprise?
Yes
No
Minority Owned
Woman Owned
Other
CERTIFICATION DATE
Date Format: MM slash DD slash YYYY
CERTIFICATION CITY
CERTIFICATION STATE
BONDING INFORMATION
Name of Bonding Company (not agent)
Bonding Agent
NAME
ADDRESS
PHONE
BOND RATE
LARGEST BONDED JOB
BONDING CAPACITY: SINGLE:$
BONDING CAPACITY: AGGREGATE:$
ESTIMATED UNUSED BONDING CAPACITY
LARGEST ANNUAL VOLUME AT ANY ONE TIME
YEAR
HISTORY/ JOB EXPERIENCE
Average Annual Volume
Largest Project Completed
Current Backlog
PROJECT REFERENCES
List below three (3) largest jobs compiled in the past three (3) years;
including person to contact, phone number, contract amount and work performed:
JOB NAME
OWNER TO CONTACT
Phone
AMOUNT OF CONTRACT
WORK PERFORMED
JOB NAME
OWNER TO CONTACT
Phone
AMOUNT OF CONTRACT
WORK PERFORMED
JOB NAME
OWNER TO CONTACT
Phone
AMOUNT OF CONTRACT
WORK PERFORMED
INSURANCE INFORMATION
Experience Modification Rate (EMR):
Insurance Company Agency (G/L & Workers Compensation)
Name/Contact
Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Phone
Pellicano Construction is hereby authorized to investigate the references listed pertaining to performance and financial responsibility Signed on
Date Format: MM slash DD slash YYYY
Name of Company
Signed By
Title
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