Renewal Date:

Sent By:

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SUBCONTRACTOR

PRE-QUALIFICATION RENEWAL STATEMENT

Overview: Your pre-qualification has expired, or is about to expire. SubQual, LLC provides prequalification services on subcontractors that wish to be included in the bid list of the following general contractors in the Arizona market, Sundt Construction, Inc. and Summit Builders. It is the policy of these general contractors to prequalify the subcontractors prior to bidding on any of their projects. From the information provided, each general contractor will independently establish their maximum per project contract limit for subcontractors. Establishment of this maximum subcontract value is a requirement of the subcontractor default insurance carrier of these general contractors. (Subcontractor default insurance is provided in-lieu of a bond on the subcontractor.). Your prequalification status must be updated annually.

Questions can be directed to our Pre-qualification Department at (800) 407-6192 or E-Mail to .

This statement can be downloaded as a Word document in our Subcontractor Portal at www.subqual-llc.com.

Please complete as it appears on your State Contractor’s License:Legal Name of Firm:
DBA:
Address:
(city, state, zip)
State: License No: Class(es): Expiration:
State: License No: Class(es): Expiration:
State: License No: Class(es): Expiration:
State: License No: Class(es): Expiration:

Shipping Address:

(city, state, zip)

Mailing Address:

(city, state, zip)

Phone: Fax:

Web Address:

Provide names and titles of your firm’s principal contacts:

PRINCIPAL CONTACT: TITLE:

Phone: Fax:

E-Mail:

ESTIMATING CONTACT: TITLE:

Phone: Fax:

E-Mail:

indicate the area(s) that you prefer to work in:

Northern Arizona (including Phoenix and Casa Grande metro areas)

Southern Arizona (including Tucson and Yuma metro areas)

Northern California (including Sacramento metro areas)

Southern California (including Los Angeles and San Diego metro areas)

Nevada (including Reno metro areas)

Federal Work – including other states

List CSI Divisions/Trades (see page 5):

Are you willing to bid on prevailing wage projects? Yes No

For Arizona subcontractors only, please answer the following two questions:

Do you comply with all federal immigration lawsper A.R.S. 41-4401? Yes No

Do you use the E-Verifyprogram (A.R.S. 23-214, subsec. A)? Yes No

Your Company’s Minority Status:

Please check all that may apply and provide proof of certifications*:

County, City, State and Transportation Departments:

DBE Disadvantaged Business Enterprise*

DVBE……………Disabled Veterans Business Enterprise*

MBE Minority Business Enterprise*

SBE Small Business Enterprise*

WBE Woman Business Enterprise*

Federal Contracts (DoD) / Small Business Administration:

(Small Disadvantaged Businesses and HubZone Businesses must be certified by the SBA and registered in the CCR /Pro-Net system. For more information visit www.ccr.gov)

HBCU/MI Historically Black Colleges Universities/ Minority Institutions*

HUBZone-SB Historically Underutilized Business Zone*

LB Large Business

SB Small Business*

SBA 8(a) Small Business Administration 8(a)*

SDB Small Disadvantaged Business*

SD-VOSB Service Disabled Veteran Owned Small Business*

VOSB Veteran Owned Small Business*

WOSB Women Owned Small Business*

Minority Ownership

Native American (includes American Indian, Eskimo, Aleut & Native Hawaiian)

ANC-LB…………Alaskan Native Corporation and Indian Tribes – Large Business

ANC………...…..Alaskan Native Corporation and Indian Tribes

Annual Largest Single General

Year Sales Contract Value Contractor

2008 / $ / $

Safety: Experience Modification Rate for 2008

Federal Tax ID:

Dunn & Bradstreet Number:

Current Bonding and Banking Information:

Surety Company: Broker:

Contact Person: Phone:

Name of your bank:

Address:

Contact Person: Phone:

Line of credit: $ Unused portion: $ Expiration date:

IN ORDER TO BE PRE-QUALIFIED FOR MORE THAN $50,000, THE FOLLOWING MUST BE PROVIDED ANNUALLY:

·  A letter from your Surety outlining the single project and aggregate amounts they will issue a performance and payment bond for (we are not asking for a bond).

·  A copy of your latest (consolidated) financial statements, i.e., Balance Sheet, Income Statement, etc., prepared by an outside accounting firm (Audited, Reviewed or Compiled Financial Statements) AND a copy of your most recent internal financial statements.

v  Please be assured that your financial information will be kept confidential in accordance with our Subcontractor Portal Privacy Statement. For more information visit www.subqual-llc.com and select Subcontractor Portal.

v  Your pre-qualification status cannot be renewed until the pre-qualification statement is accurately completed, a letter from your surety is received and the necessary financial statements are provided.

By signing the SubQual, LLC Subcontractor Pre-Qualification Statement (“Statement”) you authorize the release of the submitted information as set forth in the Statement to Sundt Construction, Inc. (“Sundt”) and Summit Builders (“Summit”). This information will be used by Sundt and Summit to independently establish their maximum per project contract limit for your company.

Completed by:

Title:

Date:

If for any reason you do not wish to remain on our bid list, please provide a brief explanation below. Thank you.

Explanation for removal from bid list:

Submit to:

SubQual, LLC

Attn: Pre-Qualification Department

P.O. Box 80577

San Diego, CA 92138

Or by Confidential Fax: (800) 407-6194

Or by Confidential E-mail:

CSI Divisions/Trades:

(Please circle or check the trade(s)that your company is interested in bidding)

1000 / General Conditions / 5810 / Expansion Joint Covers / 11130 / Audio-Visual Equipment
1140 / Survey & Layout / 6110 / Wood Framing / 11150 / Parking Control Equipment
1400 / Material Testing / 6250 / Prefinished Paneling / FRP / 11160 / Loading Dock Equipment
1430 / Security Guard Firms / 6400 / Architectural Woodwork / 11170 / Solid Waste Handling Equipment
1435 / Chemical Toilets / 6415 / Countertops / 11190 / Detention Equipment
1440 / Cleaning Services / 6500 / Structural Plastics / 11200 / Water Treatment Equipment
1480 / Jobsite Trailers / 6600 / Plastic Fabrications / 11210 / Supply/Treatment Pumps
1530 / Temporary Fencing / 7100 / Dampproofing/Waterproofing / 11220 / Mixers And Flocculators
2110 / Excav., Removal, Haz. Matl / 7160 / Cementitious & Reactive W.P. / 11225 / Clarifiers
2115 / U.G Storage Tank Removal / 7170 / Bentonite Waterproofing / 11230 / Water Aeration Equipment
2145 / Groundwater Treatment Sys. / 7180 / Traffic Coatings / 11240 / Chemical Feed Equipment
2210 / Subsurface Investigation / 7210 / Building Insulation / 11250 / Water Softening Equipment
2220 / Demolition / 7240 / Exterior Insul. Finish Syst. / 11260 / Disinfectant Feed Equipment
2250 / Shoring And Underpinning / 7410 / Metal Roof And Wall Panels / 11270 / Fluoridation Equipment
2300 / Earthwork / 7510 / Built-Up Bituminous Roofing / 11285 / Hydraulic Gates
2310 / Asphalt Paving / 7570 / Coated Foamed Roofing / 11295 / Hydraulic Valves
2360 / Soil Treatment / Termite Cntrl / 7620 / Sheet Metal Flashing/Trim / 11300 / Waste Treatment/Disposal Equip.
2455 / Driven Piles / 7720 / Roof Accessories / 11310 / Sewage And Sludge Pumps
2475 / Caissons / 7810 / Applied Fireproofing / 11320 / Grit Collecting Equipment
2500 / Site Utilities / 7920 / Joint Sealants / 11330 / Screening/Grinding Equipment
2620 / Drywells / 8110 / Steel Doors And Frames / 11335 / Sedimentation Tank Equipment
2632 / Storm Drainage / 8210 / Wood Doors / 11340 / Scum Removal Equipment
2660 / Ponds And Reservoirs / 8300 / Specialty Doors / Won Doors / 11345 / Chemical Equipment
2770 / Curbs And Gutters / 8320 / Detention Doors And Frames / 11350 / Sludge Hand./Treatment Equip.
2780 / Unit Pavers / 8360 / Overhead Doors / 11360 / Filter Press Equipment
2790 / Athletic/Recreation Surfaces / 8460 / Automatic Entrance Doors / 11365 / Trickling Filter Equipment
2815 / Fountains / 8500 / Windows / 11370 / Compressors
2820 / Fences And Gates / 8600 / Skylights / 11375 / Aeration Equipment
2830 / Retaining Walls / 8700 / Hardware / 11380 / Sludge Digestion Equipment
2840 / Striping / 8800 / Glazing / 11385 / Digester Mixing Equipment
2870 / Site Furnishings / 8950 / Translucent Wall/Roof Assem. / 11390 / Pkg. Sewage Treatment Plants
2890 / Traffic Signs And Signals / 9210 / Cement Plaster / 11400 / Food Service Equipment
2895 / Markers And Monuments / 9250 / Gypsum Board / 11600 / Laboratory Equipment
2900 / Planting, Landscape & Irrig. / 9310 / Ceramic Tile / 12310 / Manufactured Metal Casework
2905 / Native Plant Salvage / 9400 / Terrazzo / 12320 / Manufactured Wood Casework
3150 / Concrete Accessories / 9510 / Acoustical Ceilings / 12490 / Window Treatments
3200 / Concrete Reinforcement / 9650 / Resilient Flooring / 12600 / Systems Furniture
3300 / Cast-In-Place Concrete / 9670 / Fluid Applied Flooring / 13110 / Cathodic Protection
3400 / Pre-Cast Concrete / 9680 / Carpet / 13120 / Pre-Engineered Structures
3520 / L.W. Conc. Roof Insulation / 9900 / Paints And Coatings / 13150 / Swimming Pools
3530 / Gypsum Concrete / 10115 / Markerboards / 13200 / Storage Tanks
4000 / Masonry / 10160 / Metal Toilet Compartments / 13230 / Digester Covers/Appurtenances
4400 / Stone / 10200 / Louvers And Vents / 13280 / Hazardous Material Remediation
4720 / Cast Stone / 10260 / Wall And Corner Guards / 13400 / Measurement/Control Instrument
4910 / Unit Masonry Restoration / 10270 / Access Flooring / 13700 / Security Access/Surveillance
5120 / Structural Steel / 10300 / Fireplaces And Stoves / 14200 / Elevators
5140 / Structural Aluminum / 10350 / Flagpoles / 14300 / Escalators And Moving Walks
5150 / Wire Rope Assemblies / 10400 / Identification Devices / 14550 / Conveyors
5200 / Metal Joists / 10430 / Exterior Signage / 14600 / Hoists And Cranes
5300 / Metal Deck / 10500 / Lockers / 15300 / Fire Protection Piping
5330 / Aluminum Deck / 10520 / Fire Protection Specialties / 15400 / Plumbing Fixtures/Equipment
5510 / Metal Stairs And Ladders / 10550 / Postal Specialties / 15700 / Heating, Ventilating, A/C Equip.
5520 / Handrails And Railings / 10605 / Wire Mesh Partitions / 15935 / Building Systems Controls
5530 / Gratings / 10650 / Operable Partitions / 16000 / Electrical
5560 / Metal Castings / 10705 / Exterior Sun Control Devices / 16700 / Communications
5650 / Railroad Track/Accessories / 10800 / Toilet, Bath, Laundry Access.
5700 / Ornamental Metal / 10880 / Scales

SubQual, LLC Subcontractor Prequalification RENEWAL Web Form, rev. 01/08/09 Page 5 of 5