Titan Realty & Construction - Contractor Qualification Form
Name:
*
Company Name
*
E-mail:
*
Phone:
*
Fax:
*
Address:
*
City:
*
State:
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AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip code:
*
Type Of Business:
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Corporation
Sole Proprietorship
Partnership
Other
Select Your Trade:
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Masonry
Electrician
Plumber
HVAC
Carpentry
Paving
Excavation
With whom, within your Company should we contact regarding:
Estimating Work:
Contract Agreements:
Scheduling The Work:
Insurance Certificates:
Accounting & Invoices:
We would like to know who the Principals of your Company are:
Name & Title:
*
Name & Title:
Name & Title:
Labor Type:
Please check one: Do you employ?
*
Union
Non-Union
If you employ union staff, please provide their Labor Local #:
Is your Company:
Minority Owned
Coalition
Open Shop
Please list the Licenses & License #'s which your Company has (If Applicable):
License Type & #:
License Type & #:
License Type & #:
License Type & #:
List the Insurance that your Company carries:
Workers Compensation:
Limits:
Expiration Date:
Carrier:
Broker:
General Liability:
Limits:
Expiration Date:
Carrier:
Broker:
Excess Liability
Limits:
Expiration:
Carrier:
Broker:
Completed Operations:
Limits:
Expiration:
Performance & Payment Bond Limit (If Any):
Limits:
Surety:
Agent:
Please provide the following financial & business information:
The year the Company was started:
Number of skilled production labor:
Federal Tax I.D. #:
Please provide 4 projects you feel best express the type, size and quality of your work:
#1. Project Name/Client:
*
Project Location:
*
Contract Value:
*
#2. Project Name/Client:
Project Location:
Contract Value:
#3. Project Name/Client:
Project Location:
Contract Value:
#4. Project Name/Client:
Project Location:
Contract Value:
Please list 3 client references:
#1. Reference Company:
*
Contact Person:
*
Phone Number:
*
#2. Reference Company:
*
Contact Person:
*
Phone Number:
*
#3. Reference Company:
Contact Person:
Phone Number:
Please check the geographical areas which you most prefer to work:
Check all that apply:
*
Manhattan
Queens
Brooklyn
Staten Island
Westchester
Bronx
Nassau
Suffolk
New Jersey
Connecticut
What are your Company's preferred financial limits of projects (i.e., contract amounts which your Company is most comfortable with.):
Minimum Project Size:
Maximum Project Size:
If you have any additional comments, please enter them here:
Thank you for taking the time to complete this form. Once submitted, we will review your form and if qualified, you will be added to our Vendor Database for active projects.