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Sub-Contractor
Information form

Construction
Site Rules

Sample Certificate
of Insurance

W-9

Sub-Contractor Information Form

 

Company Name:

 

Contact:
 

Address:

 

City:

  State: Zip:

 

Phone:

  Fax:

 

Cell:

  Email:
 

Website:

 

 

 
   
 

Profile Information:
 

Trade (s) Performed:

 

Division (s):

 

States you
work in:

 

Willing to travel:

Yes  No

 

Work Experience:

New  Alterations/Rehabilitations  Interior Fit-Ups
 

Typical Project Size:

$

 

Years in Business:

   Number of Employees:
 

Labor Affiliation:

 Union  Non-Union  Prevailing Wage
     
  Business Certifications: (Check all that apply)
(Documentation from any local, state or federal agency that has certified your company should be submitted along with your W-9 and Insurance forms)

Minority Business Enterprise (MBE)
Women Business Enterprise (WBE)
Small Business Enterprise (SBE)

 Disadvantaged Business Enterprise (DBE)
Local Business Enterprise (LBE)
Veterans Business Entprise (VBE)
 

Business Certifications / Other:
 

Manufacturer Certifications:
 

 

  
 

Projects Recently Completed: (List 3)
 

Project Title:
 

Location
 

Trade (s) Performed:
 

Contract Amount:

 $  Date Completed mm/dd/yyyy
 

Owner/CM/GC:
 

 

  
 

Project Title:
 

Location
 

Trade (s) Performed:
 

Contract Amount:

 $  Date Completed mm/dd/yyyy
 

Owner/CM/GC:
 

 

  
 

Project Title:
 

Location
 

Trade (s) Performed:
 

Contract Amount:

 $  Date Completed mm/dd/yyyy
 

Owner/CM/GC:
 

 

  
  Bond Information:
 

Bonding Capacity:

Per Project:

$

Aggregate:

$

Bonding Rate:

 $
 

Surety Company:
 

Contact:
 

Address:
 

Phone:

  Fax:

 

Email:
 

 

  
 

Legal & Financial Information
 

Type of Business:

 Corporation  Partnership  Sole Proprietorship
     
 

Bank Reference:
Bank:
Contact:
Title:
Address:
Phone:   Fax:
Email:
     
  Insurance (Limits and Coverage Type)
   
Workmen's Comp $
Excess/Umbrella Liability $
General Liability $
Automobile Liability $
 

 

  
 

Insurance :
Company:
Contact:
Title:
Address:
Phone:   Fax:
Email:
     
 

Safety Information:
   

Yes No     Does your company document safety procedures?
   

Yes No     Does your company conduct onsite safety inspections?
   

Yes No     Does your company conduct onsite safety meetings?
     
  Experience Modification Rate (EMR) (List last 3 years):
 

State:
Year:

Year:

Year:
EMR:

EMR:

EMR:
     
 

Interstate:
Year:

Year:

Year:
EMR:

EMR:

EMR:
     
    By submitting this form you certify that the above information is
accurate, correct and true.
     
 

Completed by:

   Title:
     
   

     
 

All supporting documents should be sent to:

Sitetec Construction Co.

ATT:  New Vendor Information

6132 Brookshire Blvd., Suite C

Charlotte, NC 28216

 

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© 2009 Sitetec Construction Co.
Sitetec Construction Co. • 6132 Brookshire Blvd., Suite C, Charlotte NC 28216 • Toll Free 888 414 3055 • Tel 704 394 6969 • Fax 704 394 0462

   
         

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