Irish Construction Company
Subcontractor / Supplier Pre-Qualification Form
General Information
Company Name:
Address:
City:
State:
Zip:
Phone Number:
Fax Number:
Contact Name:
Email Address:
Company Website:
 
Type of Business:  Corporation  Sole Proprietor  Partnership  Joint Venture  DBA  Other
 
Divisions of Work:   01-General Conditions 02-Site Work-Excavations,Bridges,etc 03-Concrete
04-Masonry 05-Metals 06-Wood & Plastic-Lumber,Decking,etc
07-Thermal and Moisture Protection-Roofing,etc 08-Doors & Windows
09-Finishes-Ceiling Tiles,Flooring,Carpet,etc 10-Specialties-Toliet Partitions,Louvers,Chalk Boards,etc
11-Equipment-Banks,Libraries,Waste,Coolers,etc 12-Furnishings-Blinds,Furniture,Casework,etc
13-Special Construction-Environmental,Metal Buildings,etc 14-Conveying Systems-Elevators,Material Handling 15-Mechanical 16-Electrical
 
Incorporated / Formation Date:  Month  Day  Year
 
Tax ID#:     EEO Compliant:  Yes  No
 
Have you ever been in business under any other name?  Yes  No
  If yes, please provide name(s):  Business Name:  Year:
     Business Name:  Year:
 
If Minority Status, please indicate and email certificate to janetpolicella@irishconstructionco.com
DBE (Disadvantaged) MBE (Minority Business) SBE (Small Business)
VBE (Veteran Owned) WBE (Women Owned)  
Work History / Experience
Product Division: Specification of Professional Services Offered
Material Supplier  Subcontract Scope of Work Performed
 
Largest jobs in the last three years:
1.
 Owner:
  Architect:
  CM or GC Contact Name:
  Contract Value:
  Project Description:
 
2.
 Owner:
  Architect:
  CM or GC Contact Name:
  Contract Value:
  Project Description:
 
3.
 Owner:
  Architect:
  CM or GC Contact Name:
  Contract Value:
  Project Description:
     
Average Contract Size:
Range of Contracts: -
References
Clients
 
Company Name
Contact
Telephone
1.
2.
3.
       
Suppliers
 
Company Name
Contact
Telephone
1.
2.
3.
Claims and Litigation History
Has your company been involved in any of the following in the past five years?
1.
 Construction Defects or Warranty Issues Yes No
2.
 Not Completed Work Under Contract Yes No
3.
 Surety Action Yes No
4.
 Filed Any Lawsuits or Requested Arbitration Yes No
5.
 Been Assesse Liquidated Damages Yes No
6.
 Fringe Benefit Fund Garnishment Yes No
7.
 OSHA Safety Violations Yes No
8.
 Bodily Injury Yes No
9.
 Mechanic's Liens Yes No
10.
 Other Yes No
  If you answered Yes to any of the above, please email details in an attachment to janetpolicella@irishconstructionco.com
Insurance
Please Email Current Certificate Listing Limits Prior to janetpolicella@irishconstructionco.com
 
General Liability and Workers Compensation / Employer liability Insurance Carrier:
Name:
Address:
City:
State:
Zip:
Telephone Number:
   
General Liability and Workers Compensation / Employer liability Insurance Agent:
Name:
Address:
City:
State:
Zip:
Telephone Number:
Safety
Workers Compensation Experience Modifier (EMR) in the Last Three Years:
Year / EMR
Year / EMR
Year / EMR
/
/
/
 
Does your company have a safety, health and accident prevention program? Yes No
Does your company hold weekly "Tool Box Talks"? Yes No
Does your company have new-hire training? Yes No
Does your company have OSHA required training? Yes No
 
Affiliation:     Non-Union Since: Month Year     Union Since: Month Year
 
Number of Employees:     Office:     Field:     Percent of work performed by own forces:
Bonding
Is your operation bondable? Yes  No
If yes, total bonding capacity:
   
Surety Company Name:
Surety Agent Contact Name:
Surety Agent Phone:
Surety Agent Email:
   
Value of Current Work Bonded:
Single Project Bonding Limit:
Financial Information
Name of Bank:
Contact:
Address:
City:
State:
Zip:
Telephone Number:
Email Address:
D&B Number:
Other:
   
Email Full Financial Statement for the Latest Full Calendar Year to janetpolicella@irishconstructionco.com
   
Email Work in Progress Schedule to janetpolicella@irishconstructionco.com
   
List Annual Sales for the Last Three Years:
Year / Amount
Year / Amount
Year / Amount
/
/
/
Authorized Signature
The undersigned is an officer, principal or authorized by power of attorney to enter into legal, binding transactions for Subcontractor and as such accepts the above requirements, and certifies that all answers are complete and accurate.
 
Authorized Submission Contact Name:
Authorized Submission Title: