Erland Construction, Inc.

Statement of Subcontractor Qualifications

Statement of Contractor’s Qualifications

Date: Contractor Registration Number:

Major Trade:

About Your Company

1) / Legal Company Name:
DBA: / Parent Company:
Address: / City: / State: / Zip:
Primary Contact:
Phone: / Fax: / Email:
Estimating Contact:
Phone: / Fax: / Email:
2) / Years in business: Corporation LLC Partnership
3) / List of Company Officers & Percentage of Ownership
Name /
Title
/ Ownership
%
%
%
%
4) / Total Number of Employees: / Office: / Field: / Shop:
5) / Are the personnel of your company or any of your subcontractors…?
All Employees All Independent Subcontractors A Mix of Employees and Independent
6) / List Geographic Areas Served:
7) / A. Do you qualify as a SOMWBA approved Minority Business Enterprise (MBE)? / Yes No
B. Do you qualify as a SOMWBA approved Women Owned Enterprise (WBE)? / Yes No
C. Do you qualify as a Small Business Enterprise (SBE)? / Yes No
D. Have you had experience with LEED, Green or Energy Star projects? / Yes No
8) / If you use independent contractors, do they do work that is customarily performed by your own employees?
Yes No N/A
Please explain.
9) / List Trades and States in which Company Holds Licenses:
Trade: / State: / License Number:
Trade: / State: / License Number:
Trade: / State: / License Number:
Trade: / State: / License Number:
10) / List Major Services and/or Products Your Company Can Provide:
Trade: / % Self Performed/Subcontracted
Trade: / % Self Performed/Subcontracted
Trade: / % Self Performed/Subcontracted
Trade: / % Self Performed/Subcontracted
Trade: / % Self Performed/Subcontracted
11) / Is your company capable of coordinating your shop drawings/work using Virtual Construction Techniques?
Yes No Will have within 12 months
If yes, is it done: In-house Through Outside Company (Name of Company):
12) / Are you signatory to any labor agreements? / Yes No / If yes, which unions?

References

13) / Bank Reference
Bank: / Contact: / Phone:
Bank: / Contact: / Phone:
14) / List Six Trade References & Three General Contractor References (Company, Contact, & Phone):
Trade
1.
2.
3.
4.
5.
6.

General Contractor

1.
2.
3.
15) / Attach a list of all major projects completed within the past three years labeled as Attachment A. Include:
1.  Project Name 4. Contact Name & Phone Number
2.  Owner 5. Start & Completion Dates
3.  General Contractor 6. Contract Amount
16) / Attach a list of three major projects presently under construction labeled Attachment B. Include:
1.  Project Name 4. Contact Name & Phone Number
2.  Owner 5. Start & Completion Dates
3.  General Contractor 6. Contract Amount

Past Performance

17) / Have you ever failed to complete a project? / Yes No
If yes, please explain.
18) / Has your company (or any of its owners, officers, or major shareholders) ever petitioned for bankruptcy, been terminated on a contract or failed to complete work awarded to it? Yes No
If yes, please explain.
19) / Is your company (or any of its owners, officers, or major shareholders) currently involved in any arbitration or
litigation or does it have any outstanding judgments or claims? Yes No
If yes, please explain.
20) / Is your firm a member of any trade/business associations? Yes No
If yes, which ones?

Safety

21) / Do you have a written safety program? / Yes No
If yes, attach a copy of the program as Attachment C.
22) / Do you require your field employees to be OSHA 10-Hour certified? / Yes No
If no, please describe the safety training you provide as Attachment D.
23) / Have you been sited by OSHA for safety violations within the last four years? / Yes No
If yes, please explain.

Insurance

24) / Standard limits of Insurance Coverage: / Provide a sample certificate of insurance as Attachment E
25) / A. Please Provide the Contact Information on Your Insurance Agent/Broker:
Company: / Contact:
Phone: / Fax: / Email:
26) / Bonding/Surety Information
Surety Name:
Bonding Agent Company:
Primary Contact:
Address:
City: / State: / Zip:
Phone: / Fax: / Email:
A. Bonding Capacity per Job:
B. Bonding Capacity Aggregate:
C. Bond Premium Rate:
D. Date of Last Bond Issued:
27) / Who, within your company, is the primary point of contact for insurance and bonding related issues?
Contact: / Title:
Phone: / Fax: / Email:
28) / Workers Compensation Modification Rating (EMR for last three years)
2009: / 2010: / 2011:
29) / Do you offer health insurance for your employees? / Yes No
If yes: / Full coverage Partial coverage

Education and Training

30) / Do you provide reimbursement to employees for educational programs they participate in?
Full Partial None
31) / What means do you use for employee training? (Indicate all that apply.)
In-house Training Programs / Yes No
Gould Institute (ABC) / Yes No
Trade School Programs / Yes No
Continuing Education Programs / Yes No
Seminars and Workshops / Yes No
Union Apprenticeship Programs / Yes No

Financial Statement

32) / List Revenue Volume for the Past Three Years:
Private Work: / 2009 / $ / 2010 / $ / 2011 / $
Public Work: / 2009 / $ / 2010 / $ / 2011 / $
33) / Current Backlog of Uncompleted Work: / $
34) / Company Net Worth: / $
35) / Average Sized Project Your Company Performs: / $
36) / Minimum Size of Job Your Firm Will Perform: / $
37) / Maximum Size of Job Your Firm Will Perform: / $
38) / A review of subcontractor’s financial statement will be required prior to any invitation to a select bid list (Erland negotiated project) or award of project to the subcontractor.
Reviewing of Subcontractor Financial Statement information is a crucial and necessary part of the pre-qualification process, Erland does realize the confidential nature of these documents. Please be confident that this information will be handled with the greatest respect to your firm's privacy.
Submitted By:
Signature: / Title:
ALL COMPLETED FORMS CAN BE MAILED, FAXED or E-MAILED TO:
Gail M. P. DalyErland Construction, Inc. | 71 Third Avenue | Burlington, MA 01803
t: 781-272-9440 | f: 781-272-8370 | e:


4 of 5