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We invite you to join our team.
Help us be successful - together!
We invite you to join our team. Help us be successful - together!
General Information
Corporate Name
Organization Type
Mailing Address
Owner Name
Email Address
Phone Number
Business Organization and History
Date of Corporation
State of Incorporation
Do you have other subsidiaries? Specify
Labor Agreements / Name of Union
Jurisdiction and Expiration date
Do you subcontract trades? If yes, which?
MBE / WBE / SBE / VOSB Certification
Yes
No
Is your organization a certified Minority Business Enterprice (MBE), Woman Business Enterprise (WBE), Small Business Enterprise (SBE), Service-Disabled Veteran Owned Business (SDVOB), or any other type of certified business enterprise?
If yes, which?
Other
State
City
Federal
Clarify certification
Certification number
Certification date of expiration
Submit copy of Union Certification
Upload File
Insurance and Bonding
Submit sample Certificate of Insurance
Upload File
Submit NY Construction Certificate of Liability Insurance Addendum Accord 855 NY
Upload File
What is your Bonding Single Project Limit?
What is your Bonding Aggregate Limit?
Name of Bonding Agent and address
Yes
No
Are there any open or aggregate liability claims that whould impair your ability to insurance a project?
If yes, explain
Financial Information
What is your D&B number?
What is your Bank name and address?
Do you have a line of credit? If yes, clarify bank and max. amout
If a loan is outstanding, clarify amount
Clarify Lender's name and address
Safety Rating
List your firm's EMR for the past 3 years
Current EMR
Previous EMR
Two years prior EMR
Provide copy of your endorsement confirming your EMR
Upload File
Yes
No
Has your company committed an OSHA violation in the last 5 years?
If yes, describe
Yes
No
Has your company or its key personnel been investigated?
If yes, describe legal case(s)
Yes
No
Do your laborers carry 30 hour NYC Site Safety Certification?
Yes
No
Do your laborers hold OSHA SST cards?
Yes
No
Do you have a written employee Safety and COVID-19 policy?
Yes
No
Are there any open or aggregate liability claims that would impair your ability to insure any projects?
If yes, attach explanation
Upload File
Legal Information
Yes
No
Has the company or any of its officers, owners or managers had any business-related licenses, certificates or certifications revoked?
If yes, describe
Yes
No
Has your company or any of its affiliates been subject to any of the following actions by a City, State, Federal, public or quasi-public government agency, authority, corporation, public development corporation or local development corporation?
If yes, describe
Yes
No
Been suspended, debarred, disqualified, had its prequalification revoked or otherwise declared ineligible to bid or perform work?
If yes, describe
Yes
No
Been barred from bidding or denied a contract despite being the low bidder?
If yes, describe
Yes
No
Been defaulted on any contract?
If yes, describe
Yes
No
Had a contract terminated for cause?
If yes, describe
References
List Current Projects under contract, including name, scope of work, contract amount and completion date
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3
List (5) Client References, including Name, Phone Number and Email
1
2
3
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5
I hereby certify the information provided is true, if submitted in a court of law.
Submit
* Required