Page 1 of 3

Pre-Qualification Form
  1. General Company Information

  2. Company's legal name*
  3. Address*
  4. City*
  5. State*
  6. Zip/postal code*
  7. Phone*
  8. Fax
    Invalid Input
  9. Website*
  10. Years in business under present firm name*
  11. EIN*
  12. Is your firm owned or controlled by another organization?*

  13. If yes, please name parent organization.*
  14. Are there any affiliated subsidiaries?*

  15. If yes, please name affiliated subsidiaries.*
  16. Company principals*
  17. Estimating contact*
  18. Email*
  19. Pre-Qualification Form Completed By

  20. Name*
  21. Title*
  22. Phone*
  23. Fax
    Invalid Input
  24. Email*
  25. Type of Company*

  26. If other, please specify.
  27. List the geographical area(s) in which you work.*
  28. Type of workers you normally employ.*

  29. Total current number of employees*
  30. List trades/operations normally performed with own forces*
  31. What approximate percentage of work is normally subcontracted, if any?
  32. Do you use leased workers or temporary workers from staffing companies or agencies?*

  33. Preferred project size*
    (List an approximate range, such as $50K-$250K, >$250-500K, > $500-1.0M, >1.0-2.0M, >$2M, etc.)
  34. Largest project completed within past three years

  35. Name*
  36. Address*
  37. Architect & general contractor names*
  38. Date of completion*
  39. Contract amount*
  40. One major project currently underway

  41. Name*
  42. Address*
  43. Architect & general contractor names*
  44. Anticipation date of completion*
  45. Contract Amount*
  46. Annual dollar volume for past three completed years*
  47. Has any parent, subsidiary, brother/sister corporation, or any other company affiliated with your company been involved in any bankruptcy or reorganization processing (e.g. declared bankruptcy, or been placed into bankruptcy, etc.) within the last ten years?*

  48. Are there any judgments, claims, arbitration proceedings, or suits pending/outstanding against your firm or its officers or principals?*

  49. Has your firm filed any lawsuits or requested arbitration or mediation with regard to contracts within the last three years?*

  50. Has your company ever defaulted or failed to complete any contract?*

  51. Has your company ever been terminated from a contract?*

  52. Has your company ever been assessed liquidated damages?*

  53. Has your company received any labor law violations (i.e. other than OSHA)?*

  54. Has your company ever had a license revoked or suspended?*

  1. Surety Information

  2. Current surety company*
  3. Broker agent name*
  4. Single project bonding capacity*
  5. Aggregated bonding capacity*
  6. Insurance Information

  7. Have you reviewed Paradigm’s Insurance requirements and fully meet them?*

  8. Insurance broker name*
  9. Contact name*
  10. Contact number*
  11. Contact email*
  12. Attach copy of your company's certificate of insurance*
  13. Safety Information

  14. Highest ranking company safety professional
  15. Name*
  16. Title*
  17. Phone*
  18. Email*
  19. Has only safety duties?*

  20. If no, list and describe other duties and responsibilities.*
  21. Certifications/credentials (e.g. CSHO, CHST, OHST, ASP, CSP, etc.)*
    May simply list safety & health courses completed.
  22. Reports to*
  23. Does your company have a written safety and health program?*

  24. Does your company perform background checks on the employees that it hires?*

  25. If so, what is the basic criteria (e.g. misdemeanors or felonies convictions involving drugs, theft, or violence within the past 5 or 7 years, respectively*
  26. Do your company regularly perform safety and health training for its employees as required by regulatory guidelines (e.g. OSHA)?*

  27. Does your company have a safety competent person on a project at all times?*

  1. OSHA Incidence Rates & Related Information

  2. Total recordable incidence rate (TRIR) for last 3 completed years*
  3. Days away/restricted-duty or job transfer rate (DART) for last 3 completed years*
  4. Current number of total recordable incidents (YTD)*
  5. Current number of recordable incidents with lost time or days away from work (YTD)*
  6. Has your firmed every incurred a fatality?*

  7. Experience Modification Rate (EMR)
  8. Provide the EMR for the past 3 years*
  9. If you lack an EMR for any year, please provide an explanation.*
  10. OSHA Inspections
  11. Has your company been issued any citations within the past 3 years?*

  12. Has your company had any OSHA inspection within the past 3 years that did not result in citations?*

  13. Credit References

  14. Please list a credit reference*
    Company name, Contact name, Title/Position, Number, Email
  15. General Contractor/Construction Manager

  16. Please list a GC/CM reference*
    Company name, Contact name, Title/Position, Number, Email
  17. Customer/Client References

  18. Please list a customer/client reference*
    Company name, Contact name, Title/Position, Number, Email