Pre-Qualification

APPLICATION

Chris-Tel Construction will use this document to prequalify contractors. Therefore, if you would like to be considered for a future project, please complete the application as requested.

Today's Date

STRUCTURE OF COMPANY

Date of Establishment*

State Where Established

How long has your company been in business?*

How long using the same license number?*

Upload W-9

Max. file size: 10 MB.

SAFETY – OSHA

Total # of OSHA Recordable Incidents (Total of Columns H, I, & J on the OSHA 300 Log)*

Last Year

1st Prior Year

2nd Prior Year

Total # of Lost Work Day Incidents (Column H on the OSHA 300 Log)*

Last Year

1st Prior Year

2nd Prior Year

Total # of Fatalities (From Column G on the OSHA 300 Log)*

Last Year

1st Prior Year

2nd Prior Year

INSURANCE/BONDING

Sample Insurance Certificate*

Max. file size: 10 MB.

Please attached a sample insurance certificate showing current limits

Bonding Capacity*

Total Capacity

Capacity Per Job

Has your company ever been assessed liquidated damages for late completion of a project?*

Yes

No

If yes, please explain:

CERTIFICATIONS/COMPLIANCE

Does your company participate in E-Verify?*

Yes

No

Is your company a certified disadvantaged business?*

Yes

No

DBE Certification

Max. file size: 20 MB.

Please upload DBE Certification

Are you willing to work on Davis Bacon prevailing wage projects?*

Yes

No

SIGNATURE

Chris-Tel Construction will use this document to pre-qualify subcontractors. Therefore, if you would like to be considered for a future project, please complete the application as requested. This document should not be construed to constitute a commitment, or a request to perform any work.

Completed by*

First Last

Title*

Signature*

Date Completed*

CAPTCHA

APPLICATION

COMPANY INFORMATION

STRUCTURE OF COMPANY

COMPANY PROFILE

SAFETY – OSHA

INSURANCE/BONDING

CERTIFICATIONS/COMPLIANCE

SIGNATURE