Become a Block Companies Companies Subcontractor! Subcontractor Form Step 1 of 2 50% Application Date:Multi-Family Experience? Yes No BackgroundCompany NameType of CompanyType of Work PerformedAddress Street Address City/State/Zip Phone NumberEmail Fax NumberContact NameEmail Address Year Business Was EstablishedStates We Do Work InPrevious Name of Company (if applicable)Contractor's License #, if applicableD&B #This field is hidden when viewing the formUntitled Union Non-Union SafetyPlease check if your Company implements the following safety controls:Has a written safety program Yes No Has an implemented drug screening policy for all employees Yes No Performs safety orientation and training for all employees Yes No Performs continuing safety education for all employees Yes No Does your Company provide OSHA 10 training? Yes No Does your Company provide OSHA 30 training? Yes No If not, is your Company willing to provide OSHA 10/ 30 training, if necessary? Yes No CertificationPlease check if your Company has any of the following certifications:Qualified minority business AND/OR Section 3 certified business? Yes No **IMPORTANT: If yes, please list all certifications:Does your Company utilize apprenticeship programs? Yes No If no, is your Company willing to utilize apprenticeship programs, if necessary? Yes No ComplianceIs your Company familiar with the following?***If YES for any of the above, attach proof and/ or certifications to pre-qualification form.***Davis Bacon Wage Rates? Yes No Section 3 labor goal requirements? Yes No Certified Payroll? Yes No MWSBE goal requirements? Yes No LCPTracker? Yes No Has your Company done work on a HUD funded project that required certified payroll within the past 2 years? Yes No Compliance officer ContactPhone numberEmail address ScheduleProvide summary of the 3 largest projects completed SummaryLocationStart/CompletionAmountSummaryLocationStart/CompletionAmountSummaryLocationStart/CompletionAmountBonding InformationPlease provide the following bonding information:Can you provide a Performance Bond? Yes No Bond RatingBonding CapacitySingle ProjectAggregateBond Cost (% or $/1000)Name of Bonding companyContactPhone NumberLast type of bond issuedDateAmountBanking InformationPlease provide financial referencesName of Current BankContactPhone NumberLine of CreditAmountReferences (The below references may be contacted by Block Builders for verification purposes)Please provide 3 clients/ supplier referencesCompany NameContactPhone NumberCompany NameContactPhone NumberCompany NameContactPhone NumberPlease let us know how you heard about Block Builders, LLC?I hereby certify that to the best of my knowledge, the information submitted herein, including any attachments is true and sufficiently complete so as not to be misleading.Completed by:TitleDateBlock Builders, LLC will use this documentation to pre-qualify contractors. Therefore, if you intend to work with us, it is essential that you return the documentation. This document should not be construed to constitute a commitment, or a request to perform any work.Disclaimer: the information on this form will be shared with our partners outside of the Block Builders, LLC organization. Δ
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