Subcontractor Prequalification Form

Instructions:

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Please complete the form below and submit online or email (PDF form and requested attachments) to info@chargerlv.com. If all information is not provided and all attachments are not submitted, this will significantly delay approval of your prequalification package.

Please note that this is a preliminary prequalification form and includes only our minimum requirements. Additional information may be requested as needed. Thank you for submitting your Prequalification Package!

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Items to accompany Subcontractor Prequalification Form:

Insurance Certificate
Health and Safety Manual
W9
NSCB and all Contractors’ Licenses
City, State and Business Licenses
List of 5 significant projects within the last 3 years to include volume, scope of work, and contract amount
Current Project Listings

Company Information:

Company’s Legal Name:

DBA (if any):

Street Address:

Mailing Address:

Phone:

Website:

License No./Class/State:

Bid Limit:

Type of Company

State Unemployment Insurance Number:

Estimating Contact Name, Email, Phone:

Number of Employees Field / Office:

Company Principals:

Surety Information:

Surety Company:

Broker Agent Name, Email and Phone:

Broker Address:

Single Project and Aggregate Bonding Capacity:

Safety Manager Name, Email and Phone Number:

Do you have a written safety and health program/manual:YesNo

Please send a copy of your written safety and health program/manual to info@chargerlv.com

Work History:

Any active litigation with Owners/General Contractors? If yes, please explain

Any judgements against you in the last 3 years? If yes, please explain why.

Has your company ever been assessed liquidated damages? If yes, please explain why.

Any labor law violations? If yes, explain why.

Have you ever defaulted or failed to complete a contract? If yes, explain why.

Have you ever been terminated from a contract? If yes, explain why.

Have you ever had your license revoked or suspended? If yes, explain why.

Has your company ever filed Bankruptcy? If yes, explain why.

Do you have a D&B Number? If yes, please list.

Insurance Information:

Do you have a D&B Number? If yes, please list.

Company References (3):

Company Name, Contact Name & Title, Email, Address and Phone:

Credit References (3):

Company Name, Contact Name & Title, Email, Address and Phone:

Application Person Info:

Person Authorized to Sign on Behalf of the Organization, Title:

Thank you for your submission!

Please don't forget to send all additional documents to info@chargerlv.com

‍

Items to accompany Subcontractor Prequalification Form:

Insurance Certificate
Health and Safety Manual
W9
NSCB and all Contractors’ Licenses
City, State and Business Licenses
List of 5 significant projects within the last 3 years to include volume, scope of work, and contract amount
Current Project Listing

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If you're having issues, you may fill this form out manually and send to info@chargerlv.com

Subcontractor Prequalification Form

Instructions:

Items to accompany Subcontractor Prequalification Form:

Company Information:

Surety Information:

Work History:

Insurance Information:

Company References (3):

Credit References (3):

Application Person Info:

Thank you for your submission! Please don't forget to send all additional documents to info@chargerlv.com

Items to accompany Subcontractor Prequalification Form:

Thank you for your submission!

Please don't forget to send all additional documents to info@chargerlv.com