VENDOR PRE-QUALIFICATION FORM

Thank you for your interest in becoming a vendor. Please fill out the pre-qualification information below.

Once you are approved you will be able to view projects that are open for bids, and download any necessary documentation for the project.

GENERAL INFORMATION

Firm Name:
Firm Address: Phone: Fax:
Trade(s):
Contractor License #:
Name of Bid contact:
Email:
Bank References:
Material Suppliers 1:
2:
Customer References 1:
2:

COMPANY STATUS

What year did your company go into business?
Has your company ever failed to complete work awarded them?
Has your company ever been placed in default?
Has your company ever filed for bankruptcy?
Are there any legal action(s) pending against your company?

CURRENT PROJECTS

Please list a few of your current projects:
Contract amount Short Description

INSURANCE INFORMATION

Forward a current sample Insurance Certificate and Additional Insured Endorsement from your insurance agent. General liability insurance requirements are as follows:

• $1,000,000 per each occurrence, $2,000,000 general aggregate
• $1,000,000 commercial automobile liability
• Contractor, Owner, and Architect listed as Additional Insured
• Additional Insured endorsement must be CG 20 10 11 85 (or equivalent) covering completed operations
• Primary Wording
• “Per Project Aggregate” endorsement (CG-2503 or equivalent) or evidence of umbrella/excess liability.
• Insurance carriers must have an A.M. Best rating of not less than A-:VII.

Please fax your insurance information to (916) 441-2486 - ATTN: Sub Pre-Qualification.

Please include your firm name on the cover sheet.

WORKERS COMPENSATION

Workers Comp Policy#:
Workers Compensation Carrier Name:
How long have you been covered by this carrier?

BONDING INFORMATION

Payment and Performance Bond Carrier:
Bonding Capacity:    Single   Aggregate

SAFETY PRACTICES

Do you have a current written safety program?
Describe how safety training is provided

List and describe all serious OSHA citations your firm has received in the past three years

What is your current Experience Modification Rating (E.Mod)?