Subcontractor Pre-Qualification Form

Subcontractor Identity

Company Name:

Area of Expertise:

Address:

Street Address Address Line 2 City County / State / Region ZIP / Postal Code

Phone Number:

Email:

VAT Number:

Website:

Contact Person(s):

Type of Company:

Sole Trader

Limited Company

PLC

LLC

Date Company Formed:

Total Number of Employees:

Names and titles of key personnel/directors in company:

Has the company operated under any other name in the past five years?

Yes

No

If yes, give name(s):

Does the company have offices, plants, or warehouses at other locations?

Yes

No

If yes, give location(s):

Financial Information

Does the company have a line of credit from any lending institution?

Yes

No

If yes, provide details:

Lender’s Name, Address, Officer’s Name and Phone:

Safety Record

In the past five years, has your company or any of its key personnel been investigated for or found to have committed a serious H&S violation?

Yes

No

If yes, provide details:

Do you have a written employee H&S policy and program?

Yes

No

Are there any open or aggregate liability claims that would impair your ability to insure any project?

Yes (attach explanation)

No

Copy of claim:

Max. file size: 50 MB.

Insurance

Do you hold Employers Liability Insurance?

(please attach a copy)

Yes

No

Value:

Copy of Employers Liability Insurance

Max. file size: 50 MB.

Do you hold Public Liability Insurance?

(please attach a copy)

Yes

No

Value:

Copy of Public Liability Insurance

Max. file size: 50 MB.

Other Information

Has your company or any of its personnel been a party to a bankruptcy or reorganization proceeding?

Yes

No

If yes, give date:

During the past five years, have any liens been filed against you by any of your subcontractors or suppliers?

Yes

No

If yes, give details:

Have you ever failed to complete a contract, been defaulted, or had a contract terminated?

Yes

No

If yes, give dates and details:

In the past five years, has your company or any of its key personnel been involved in any lawsuits arising from client contract/projects?

Yes

No

If yes, give details:

References

(Attach extra sheet if necessary)

Trade References

(List three of your subcontractors or suppliers; include name, contact, email and phone number)

1.

2.

3.

Client References

(List three clients, include name, email and phone number)

1.

2.

3.

SSIP Accreditation

(Attach Certificate from relevant body)

Do you hold a current Certificate from an SSIP Member?

Yes

No

Name of Organisation:

Expiry Date:

File

Max. file size: 50 MB.

ISO Accreditation

(Attach Certificate from relevant body)

ISO9001

Yes

No

ISO14001

Yes

No

ISO145001

Yes

No

File

Max. file size: 50 MB.