Subcontractor Qualification Form

Qualification Form

Please fill out the fields that apply to your company, and complete all the required fields.

Company Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Fax

Email *

Contact Person *

Areas of Expertise *

About Your Company

About Your Company (Type of Company) *

Sole Proprietorship
Corporation
Partnership

Date Company Established *

Total Number of Employees *

State(s) in which company is legally qualified to do business *

Names and titles of key people in company *

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

Yes
No

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

Yes
No

D&B #

Minority Status

HUB Status

Scope of Work Performed

(include descriptions of what you self perform and what you sub out)

MBE / WBE / SBE Certification

Is the company a certified (check all that apply):

Minority Business Enterprise (MBE)
Women Business Enterprise (WBE)
Small Business Enterprise (SBE)
Other certified business enterprise

Financial Information

Do you have bonding? *

Yes
No

Single Project Limit

Aggregate Limit

Bonding Company Name

Bonding Agent Name

Bonding Company Address

Address Line 1

Address Line 2

City

State

Zip Code

Bonding Company Phone

Insurance

Coverage Type – Enter your limit amounts:

Workman's Compensation: *

General Liability *

Excess / Umbrella Liability *

Automotive Liability *

Other Information

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

Yes
No

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

Yes
No

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

Yes
No

Message

“In all projects, Northcon has conducted their business above reproach and maintained excellent communication with the COs, CORs and inspectors, providing timely responses to any issues and concerns to ensure that the project would remain on schedule and within budgets.”

~ Fred A. Fischer Retired, Sup. Contract Specialist, IMAT, Idaho Panhandle National Forests

Northcon Inc. • 10615 N. Government Way Hayden, ID 83835 • Phone: 866-772-6003 • Fax: 208-772-2533