Subcontractor/Vendor/Professional Services

SUBCONTRACTOR/VENDOR/PROFESSIONAL SERVICES

PRE-QUALIFICATION FORM

Contractor Pre-qualification Form Instructions

Page 1

Address should be the corporate headquarters if business has more than one location.
Contact is the person responsible for completing the pre-qualification form and whom we may call with questions.
Bidding location deals with information about the actual location (your firm’s branch office not the project site) which will be bidding.
Please submit additional copies of pages 1 and 2 for additional locations.

Page 2

If any boxes are checked for minority, small business or disadvantaged business, make sure to include copies of your certification.

Page 3

Bonding - Sample form included in this packet

Safety - Sample form included in this packet

PRO 3.1a (07/24/08)

SUBCONTRACTOR/VENDOR/PROFESSIONAL SERVICES

PRE-QUALIFICATION FORM

Pre-qualification Form will not be accepted unless it is completed in its entirety

Company Name:
Federal Identification No
Corporate Headquarters Information / Address
City / State / Zip Code
Corporate Phone () - / Country
Contact Name[1] / Title
Contact Phone () - / Contact Fax () -
Contact Email
Preferred method of contact E-mail Fax
Please submit the information below for each bidding location (branch offices of your firm) to pre-qualify
Bidding Location Information / Address
City / State / Zip
Bidding Contact: / Name / Title
Phone () - / Fax () -
Email
Preferred method of contact E-mail Fax
Has your Company ever worked ona LEED Certified building? / Yes No Don’t Know
Design/Build Capability: Yes No
Status: Union Non-Union
Are you ISO Certified? Yes No / Certified to Standard:
List the UCI Categories of Work that identifies the primary business of your organization: (See attached UCI Listing)
What type of work does your Company self-perform?
Geographical Information: ListStates and corresponding Counties where this location provides services/products. If work is performed in all Counties in a State, just list the State.
State:
Counties:
Have you worked in the following segments within the last 5 Years?
Health / Stadium / Civil
Education / Energy / Federal
Manufacturing
End of location information needed for each bidding location which you wish to pre-qualify
Company Type / Corporation / Sole Proprietor / Joint Venture / LLC
Partnership / DBA / Individual
If company is a subsidiary, list Parent Company name
Year business was established under present name
Business Classification (Check ALL that apply)
Based on Small Business Administration Standards ( / Ownership Ethnicity
(Check ONE of the following)
Include a copy of all certifications relative to the business classification type(s) indicated. / African American
Type / Hispanic American
Certified Small Business / Native American
Certified Small Disadvantaged Business (SDB) / Asian-Pacific American
8a Certified SDB / Asian-Indian American
Certified HUB Zone Small Business / White / Non-Minority
EDGE (Ohio)
Ownership Type (Check ALL that Apply)
Include a copy of all certifications relative to the ownership type(s) indicated.
MBE – Minority Owner Business Enterprise / Veteran-Owned Business Enterprise
WBE – Woman-Owned Business Enterprise / Disabled Veteran Owned Business Enterprise
Type of Subcontractor: / Subcontractor: / Material Supplier: / Professional Services
Information below is not required for Material Suppliers and Professional Services Companies. Please go to page 4 to sign the form and for submission information.
BANKING
Bank Name
Bank Address
Contact Name
Contact Phone () - / Contact Fax () -
Does your company have a line of credit? Secured Unsecured None
If yes, what is the amount of the line of credit? / $
Amount of available line of credit? / $
By submitting the information above, your company may be pre-qualified for contracts under $300,000. To pre-qualify for contracts above $300,000, please submit the information below.
BONDING
Is your company bondable? Yes No
ATTACH A LETTER FROM YOUR SURETY STATING TOTAL AND PER PROJECT BONDING CAPACITY.
SAFETY PROGRAM
Please submit copies of your OSHA 300A (SUMMARY OF WORK RELATED INJURIES) reports for the 3 most recent years.
Note: If you have less than 10 employees, please note as you are not required to complete OSHA Form 300A.
Experience Modification Summary
EMR – Experience Modification Rating – Contact your insurance carrier for Worker’s Compensation to obtain this information. complete the table below with the rates for the current year and the previous two years.
Year / EMR
FINANCIAL
submit the latest three years of audited financial statements or if the organization does not have audited statements, the latest three years of annual statements.
References
Three (3) client References are required. Please fill out the following section.
Company / Contact / Phone / Fax
() - / () -
() - / () -
() - / () -
The undersigned certifies under oath that the information provided herein is true and sufficiently complete so as not to be misleading.
Completed by:
(Print or Type) / (Signature)
Title:
Date Completed:

Attachments:

Bonding Letter / Financial Statements (3 years) / OSHA 300As (3 most recent years)
W-9 (for new pre-qualifications) / Minority Certifications (if any)
Return completed form with attachments to the following location ONLY. If you fax your form, please do not mail.
Barton Malow Company
Attn: Sandra Cairns – Corporate Procurement
26500 American Drive
Southfield, MI 48034
E-mail Address:
Phone: 248/436-5302
Fax: 248/436-5303
E-mail:

PRO 3.1a (07/24/08)

MASTER UCI LISTING
CONTRACTOR: / DATE:
Check applicable codes
UCI # / DESCRIPTION / UCI # / DESCRIPTION / UCI # / DESCRIPTION
01 / GENERAL CONDITIONS / 03 / CONCRETE / 08 / DOORS & WINDOWS (CONT’D)
01032 / Field Engineering / 03100 / Concrete Forms and Accessories / 08100 / Metal Doors and Frames
01045 / Mechanical Engineering/Consultant / 03200 / Concrete Reinforcement / 08200 / Wood and Plastic Doors
01046 / Electrical Engineering/Consultant / 03300 / Cast-in-Place Concrete / 08300 / Special Doors
01111 / Signage Graphics / 03310 / Concrete Curbs / 08400 / Entrances and Storefronts
01116 / Misc. CADD Services / 03312 / Concrete Paving / 08460 / Automatic & Revolving Entrance Doors
01150 / Arch Design Consultant / 03314 / Concrete Grouting / 08500 / Windows
01151 / Programming Consultant / 03350 / Concrete Finishing / 08600 / Skylights
01152 / Civil Consultant / 03380 / Post-Tensioned Concrete / 08700 / Hardware
01153 / Landscape Consultant / 03400 / Precast Concrete / 08800 / Glazing
01154 / Structural Consultant / 03500 / Concrete Toppings / 08900 / Glazed Curtain Walls
01157 / Roofing Consultant / 03900 / Concrete Restoration and Cleaning
01158 / Hardware Consultant / 09 / FINISHES
01159 / Food Serv Consultant / 04 / MASONRY / 09200 / Plaster and Gypsum Board
01160 / Sound Accou Consultant / 04200 / Masonry Units / 09300 / Tile
01161 / Lighting Consultant / 04400 / Stone / 09400 / Terrazzo
01162 / Specification Consultant / 04700 / Simulated Masonry / 09500 / Ceilings
01163 / Equipment Consultant / 04900 / Masonry Restoration and Cleaning / 09620 / Specialty Flooring
01501 / Plants (Facility Services Contractors) / 09630 / Masonry Flooring
01508 / Site Lighting (Facility Services Contractors) / 05 / METALS / 09640 / Wood Flooring
01510 / Housekeeping (Facility Services Contractors) / 05100 / Structural Metal Framing / 09650 / Resilient Flooring
01512 / Parking Lot Maintenance (Facility Services Contractors) / 05101 / Steel Erection / 09680 / Carpet
01513 / Waste management (Facility Services Contractor) / 05400 / Prefab Lightweight Metal Truss / 09700 / Wall Coverings
01514 / Snow Removal (Facility Services Contractor) / 05500 / Metal Fabrications / 09800 / Acoustical Treatment
01518 / Testing / 05700 / Ornamental Metal / 09900 / Paints and Coatings
01521 / Security (Facility Services Contractor) / 05800 / Expansion Control
01523 / Mail (Facility Services Contractor) / 05900 / Metal Restoration and Cleaning / 10 / SPECIALTIES
01614 / Computer Software/Hardware(Facility Services Contractor) / 10100 / Visual Display Boards
01617 / Rearrangement & Moves (Facility Services Contractor) / 06 / WOOD & PLASTICS / 10150 / Compartments & Cubicles
01621 / Mobile Equipment (Facility Services Contractor) / 06100 / Rough Carpentry / 10200 / Louvers & Vents
01631 / Shredding (Facility Services Contractor) / 06200 / Finish Carpentry / 10260 / Wall & Corner Guards
01638 / Survey / 06400 / Architectural Woodwork / 10270 / Access Flooring
01639 / Uniforms (Facility Services Contractor) / 06600 / Plastic Fabrications / 10290 / Pest Control
10340 / Manufactured Exterior Specialties
02 / SITEWORK / 07 / THRML&MOIST. PROT. / 10350 / Flagpoles
02110 / Abatement / 07000 / Roof Maintenance (Facility Services Contractor) / 10400 / Identifying Devices
02200 / Site Preparation / 07100 / Damp proofing and Waterproofing / 10450 / Pedestrian Control Devices
02220 / Demolition / 07180 / Traffic Coatings / 10500 / Lockers
02300 / Earthwork / 07210 / Building Insulation / 10520 / Fire Protection Services
02400 / Tunneling, Boring, and Jacking / 07220 / Roof and Deck Insulation / 10530 / Protective Covers
02455 / Driven Piles / 07240 / Exterior Insulation & Finish Sys / 10550 / Postal Specialties
02475 / Caissons / 07300 / Shingles, Roofing Tiles, Roof Covering / 10600 / Partitions (Manufactured)
02500 / Utility Services / 07400 / Metal Roofing & Siding Panels / 10670 / Storage Shelving
02600 / Retention Pond (Facility Services Contractor) / 07500 / Membrane Roofing / 10700 / Exterior Protection
02700 / Asphalt Paving / 07600 / Flashing & Sheet Metal / 10750 / Telephone Specialties
02750 / Hardscapes / 07700 / Roof Specialties and Accessories / 10800 / Toilet, Bath and Laundry Accessories
02800 / Site Improvements-Fences, Equipment & Structures / 07800 / Fire Proofing/Fire Stopping / 10880 / Scales
02900 / Landscaping & Irrigation / 07900 / Joint Sealers / 10900 / Wardrobe and Closet Specialties
11 / EQUIPMENT / 13 / SPECIAL CONSTRUCTION / 17 / TECHNOLOGY (CONT’D)
11010 / Maintenance Equipment / 13010 / Air Supported Structures / 17450 / Video over IP Systems
11020 / Security and Vault Equipment / 13080 / Sound, Vibration, and Seismic Control / 17500 / WAN Requirements
11030 / Teller and Service Equipment / 13090 / Radiation Protection / 17600 / Arch/Mech/Elec Requirements
11040 / Ecclesiastical Equipment / 13100 / Lightning Protection / 17700 / Intra-Bldg Communication Systems
11050 / Library Equipment / 13120 / Pre-Engineered Structures
11060 / Theater and Stage Equipment / 13150 / Swimming Pools / 19 / OTHER
11070 / Instrumental Equipment / 13200 / Storage Tanks / 19000 / General Contractor
11100 / Mercantile Equipment / 13700 / Security Access and Surveillance
11110 / Commercial Laundry Equipment / 13800 / Building Automation and Control
11120 / Vending Equipment / 13850 / Fire Alarm (Facility Services Contractor)
11130 / Audio-Visual Equipment / 13900 / Fire Suppression
11150 / Parking Control Equipment
11160 / Loading Dock Equipment / 14 / CONVEYING SYSTEMS
11170 / Solid Waste Handling Equipment / 14100 / Dumbwaiters
11190 / Detention Equipment / 14200 / Elevators
11200 / Water Supply and Treatment Equipment / 14300 / Escalators and Moving Walks
11300 / Fluid Waste Treatment & Disposal. Equip. / 14400 / Lifts
11400 / Food Service Equipment / 14500 / Material Handling
11470 / Darkroom Equipment / 14580 / Pneumatic Tube Systems
11480 / Athletic, Recreatnl, &Therapeutic Equip. / 14600 / Hoists and Cranes
11500 / Industrial and Process Equipment / 14800 / Scaffolding
11600 / Laboratory Equipment
11680 / Office Equipment / 15 / MECHANICAL
11700 / Medical Equipment / 15050 / Mechanical
15070 / Mech/Sound/Vibrations & Seism. Cont.
15200 / Process Piping
12 / FURNISHING / 15400 / Plumbing
12050 / Fabrics / 15700 / HVAC
12100 / Art / 15800 / Sheet Metal
12300 / Manufactured Casework / 15900 / HVAC Instrumentation and Controls
12400 / Furnishings and Accessories / 15950 / Testing, Adjusting, and Balancing
12480 / Rugs and Mats
12490 / Window Treatment / 16 / ELECTRICAL
12500 / Furniture / 16050 / Electrical
12610 / Fixed Audience Seating / 16300 / Utility Management (Facility Services Contractor)
12630 / Stadium and Arena Seating / 16700 / Communications
12660 / Telescoping Stands / 16800 / Sound and Video
12670 / Pews and Benches
12700 / System Furniture / 17 / TECHNOLOGY
12800 / Interior Plants and Planters / 17000 / Technology Administrative
17100 / Cable Plant
17200 / Data Reqmts (includes data switches)
17210 / Wireless Equipment
17220 / Servers and SAN
17225 / Thin Client
17230 / Client Computers & Peripherals
17300 / Voice Systems
17400 / Video/Audio Systems

PRO 3.1c (1003/07)

SAMPLE BONDING LETTER

March 1, 2007

To Whom It May Concern:

Re: Dependable Contractor

We, the Trustworthy Surety Company provide surety bonds for the Dependable Contractor Company. Dependable is approved for per project bonds up to $3,000,000 and an overall work program of $15,000,000.

We continue to be confident in this principal’s ability to perform and we recommend them for your favorable consideration.

This letter is not to be construed as an agreement to provide surety bonds for any particular project, but is offered as an indication of our past experience and confidence in this firm. Any specific request for bonds will be underwritten on its own merits.

Sincerely,

TRUSTWORTHY SURETY

Tom Trustworthy

Attorney-in-Fact

SAMPLE OSHA 300A FORM

[1]Note: Contact name should be the person to contact for questions regarding this pre-qualification form