Subcontractor Information Form | East Perimeter Contractors

*Contact First Name (Provide first name of preferred company contact)

*Contact Last Name (Provide first name of preferred company contact)

*Company Name

*Contact Person Email Address

*Contact Person Phone Number

*Street Address (Provide main company address)

*City

*State

*Zip Code

If applicable, please provide other office locations: (street address, city, state, and zip code)

Website Address

*Company Description

*Select the type(s) of work your company performs

Please describe your firm's primary offered scopes and services

*Please select any of the potential Pre-Construction and Early Works scopes of work available for this project that your firm is interested and qualified to perform:

*Please select any of the potential Construction scopes of work available for this project that your firm is interested and qualified to perform:

Please list applicable contractor/supplier certification/NAICS codes

*Does your firm carry any business enterprise certifications (i.e., DBE, Small Business Enterprise, etc.)?

Yes

If so, please list the type of certification and certifying agency

*What is your firm's General Liability Insurance Limit?

*What is your firm's Excess/Umbrella Insurance limit?

*What is the name of your firm's Surety company?

*What is your firm's Single Amount Bonding Capacity?

*What is your firm's Aggregate Amount Bonding Capacity?

*What is your firm's Experience Modification Rating (EMR) for 2022? (If applicable)

*What is your firm's Experience Modification Rating (EMR) for 2023? (If applicable)

*What is your firm's Experience Modification Rating (EMR) for 2024? (If applicable)

*What is your firm's Experience Modification Rating (EMR) for 2025? (If applicable)

Has your firm had any Occupational Safety and Health Administration (OSHA) lost time or violations in the past 5 years?

Yes

Please list your firm's 3 prior projects, scope(s) of work, and contract values.

Has your company performed work on any Davis-Bacon covered projects?

Yes

Has your firm work on a project that required submission of certified payrolls?

Yes

Would you like to upload additional information about your company, such as a qualifications statement or brochure? If yes, please attach materials below.

Yes

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