Name of Firm:
Parent Company:
Address Street 1:
Address Street 2:
City:
Zip Code:
(5 digits)
State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Daytime Phone:
Evening Phone:
Fax Number:
Email:
General Data
Company Type:
Choose one...
Corporation
Partnership
Sole Proprietor
Date Incorporated/Founded:
Name Principle Officers/ Owner/ Partners:
How many years of business under existing name:
Reason for name change:
Type of Work Desired/ Specialty:
Financial Status/ Dun & Bradstreet Rating:
References
Finance/ Credit References (minimum of three):
Name, phone number.
Finance/ Credit References (minimum of three):
Name, phone number.
Finance/ Credit References (minimum of three):
Name, phone number.
Business References (minimum of three):
Name, phone number.
Business References (minimum of three):
Name, phone number.
Business References (minimum of three):
Name, phone number.
Licenses:
License No. / Type of Work Covered
Offer is fully licensed in the state of California to perform
the required work?
Yes No
Company Officials
President:
Name, phone number.
Project Manager:
Name, phone number.
Authorized Negotiator:
Name, phone number.
Types of Contracts Accepted:
Cost Plus Lump Sum Unit Price
Negotiated
Personnel
Total Permanent Employees:
Employees for Field Services:
Are any of your employees covered by unions(s)?
Yes No
Do you pay union wages?
Yes No
Insurance/ Bonding
Name of Insuring Company(ies):
Workers Compensation:
Bonding Limitation of work accepted and Bonding:
Litigation
Have you at any time failed to complete a contract?
Yes No
Are there any judgements, claims or suits pending or outstanding against your?
Yes No
Geographical Radius of Operations: