subcontractor prequal form - nabholz construction

SUBCONTRACTOR PREQUALIFICATION QUESTIONNAIRE

Dear Subcontractor:

Thank you for your interest in partnering with Nabholz Construction Corporation to help build the communities we live in. Nabholz’ success is dependent on reputable, quality subcontractors.

As part of the Nabholz Construction prequalification process, each sub is required to submit and update a Subcontractor Prequalification Questionnaire on an annual basis. Please complete the attached questionnaire, in its entirety, and return to the procurement coordinator closest to your geographical location as listed on the signature page of the form, or back to the person requesting.

All information will be held in strict confidence within the Nabholz family of companies and will be utilized for in-house analysis only.

Along with the completed Subcontractor Prequalification form we also require that you provide the following list of documents to aid in our review:

☐ Current letter of good standing from surety (within the last 3 months) providing years of relationship,verification of bond rate, and single project and aggregate limits. Letter must also include the Surety’s A.M.Best Rating.

☐ Accord 25 Certificate of Liability Insurance in compliance with Nabholz requirements, as indicated onsample certificate at: http://www.nabholz.com/trade-contractors/

☐ OSHA 300/300A logs, last three years. Required for subs with more than ten employees.

Additionally, any Subcontractor whose contract is anticipated to be greater than $100,000 is required to submit the following financial information:

☐ Reference letter from bank officer stating line of credit, basis extended, how much unsecured andsecured, what security required, overall banking relationship, and years of relationship.

☐ Most recent year-end financial statement, audited or reviewed.

Nabholz subcontracts are executed in a two-part contract: In addition to the project-specific contract that defines project scope and dollar value, all subs keep a current Master Contract that defines the general terms of agreement. These two documents together form a binding contract.

Prior to submitting please check that you have:

☐ Reviewed for accuracy and completeness.

☐ Signed and dated last page.

Incomplete questionnaires will be considered expired and discarded after 90 days and must be resubmitted to be considered for review.

Thank you for your participation in our prequalification process. Nabholz owes its long history to successful relationships with clients, subcontractors, and suppliers. We look forward to building a successful relationship with your firm as well.

Sincerely,

Nabholz Construction Corporation

Conway, AR | Little Rock, AR | Jonesboro, AR | Fort Smith, AR | Rogers, AR | Springfield, MO | Lenexa, KS | Tulsa, OK | Oklahoma City, OK | Olive Branch, MS nabholz.com | 1-877-NABHOLZ

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http://www.nabholz.com/trade-contractors/


Company Information

Company Legal Name:

Dba:

State of Incorporation:

Registered with Secretary of State? Yes No

Main Construction Division

Federal Tax ID No.

Registration supplied by

Trade you specialize in

Website address

Title

City

Tel Fax

Physical Address

Street Address

State Zip

Mailing Address (If different)

PO Box City State Zip

Contacts

Name (List Main First) Title Telephone Fax Cell Email

Estimating Contact Title Telephone Fax Cell Email


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Divisions of Work

01-3223 - Survey and Layout Data01-4523 - Testing and Inspecting Services01-5423 - Temporary Scaffolding and

Platforms 01-5526 - Traffic Control01-5626 - Temporary Fencing01-7419 - Construction Waste Management

and Disposal 01-7421 - Window Cleaning01-7423 - Final Cleaning01-9100 - Commissioning02-4100 - Demolition02-4300 - Structure Moving02-8200 - Asbestos Remediation02-8300 - Lead Remediation02-8500 - Mold Remediation03-0000 - Concrete03-1100 - Concrete Forming03-1113.16 - Concrete Shoring03-2100 - Reinforcement Bars03-3000 - Cast-in-Place Concrete03-3500 - Concrete Finishing03-3513 - High-Tolerance Concrete Floor

Finishing 03-3516 - Heavy-Duty Concrete Floor

Finishing 03-3543 - Polished Concrete Finishing03-3716 - Pumped Concrete03-3800 - Post-Tensioned Concrete03-4513 - Faced Architectural Precast

Concrete 03-4713 - Tilt-Up Concrete03-5213 - Composite Concrete Roof

Insulation 03-5400 - Cast Underlayment (Gypsum or

Hydraulic Cement) 03-8113 - Flat Concrete Sawing03-8213 - Concrete Core Drilling04-0120.52 - Unit Masonry Cleaning04-0120.91 - Unit Masonry Restoration04-2000 - Unit Masonry04-4300 - Stone Masonry04-7200 - Cast Stone Masonry05-1200 - Structural Steel Framing (Supply)05-1950 - Structural Steel Erection05-4400 - Cold-Formed Metal Trusses05-5000 - Metal Fabrications05-7000 - Decorative Metal05-7313 - Glazed Decorative Metal Railings06-1000 - Rough Carpentry06-1100 - Wood Framing06-1300 - Heavy Timber Construction06-1753 - Shop-Fabricated Wood Trusses06-1800 - Glued-Laminated Construction06-2000 - Finish Carpentry

06-2200 - Millwork06-4100 - Architectural Wood Casework06-6100 - Simulated Stone Fabrications07-1000 - Dampproofing and Waterproofing07-1800 - Traffic Coatings07-2129 - Sprayed Insulation07-2400 - Exterior Insulation and Finish

Systems 07-2700 - Air Barriers07-3100 - Shingles and Shakes07-4000 - Roofing and Siding Panels07-4633 - Plastic Siding07-4646 - Fiber-Cement Siding07-5000 - Membrane Roofing07-7600 - Roof Pavers07-8100 - Applied Fireproofing07-8400 - Firestopping07-9200 - Joint Sealants07-9500 - Expansion Control08-1113 - Hollow Metal Doors and Frames08-1400 - Wood Doors08-3200 - Sliding Glass Doors08-3313 - Coiling Counter Doors08-3316 - Coiling Counter Grilles08-3323 - Overhead Coiling Doors08-3416 - Hangar Doors08-3480 – Fire Doors08-4100 - Entrances and Storefronts08-4229 - Automatic Entrances08-4413 - Glazed Aluminum Curtain Walls08-4500 - Translucent Wall and Roof

Assemblies 08-6200 - Unit Skylights08-8856 - Ballistics-Resistant Glazing09-2113 - Plaster Assemblies09-2116 - Gypsum Board Assemblies09-2423 - Cement Stucco09-3013 - Ceramic Tiling09-3033 - Stone Tiling09-5100 - Acoustical Ceilings09-5400 - Specialty Ceilings09-6200 - Specialty Flooring09-6466 - Wood Athletic Flooring09-6600 - Terrazzo Flooring09-6700 - Fluid-Applied Flooring09-6723 - Resinous Flooring09-6800 - Carpeting09-6900 - Access Flooring09-7200 - Wall Coverings09-8400 - Acoustic Room Components09-9100 - Painting09-9700 - Special Coatings10-0000 - Specialties10-1400 - Signage


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Divisions of Work (cont’d)

10-2123 - Cubicle Curtains and Track10-2219 - Demountable Partitions10-2226 - Operable Partitions10-5100 - Lockers10-7326 - Walkway Coverings10-7500 - Flagpoles10-8200 - Grilles and Screens11-1300 - Loading Dock Equipment11-1400 - Pedestrian Control Equipment11-1500 - Security, Detention, and Banking

Equipment 11-1900 - Detention Equipment11-3100 - Residential Appliances11-4000 - Foodservice Equipment11-5200 - Audio-Visual Equipment11-5213 - Projection Screens11-5300 - Laboratory Equipment11-6100 - Theater and Stage Equipment11-6600 - Athletic Equipment11-6800 - Play Field Equipment and

Structures 11-7000 - Healthcare Equipment11-9100 - Religious Equipment12-2400 - Window Shades12-3000 - Casework12-3600 - Countertops12-3653 - Laboratory Casework12-5200 - Seating12-6100 - Fixed Audience Seating12-6600 - Telescoping Stands12-9300 - Site Furnishings13-1100 - Swimming Pools13-1200 - Fountains13-2000 - Special Purpose Rooms13-2126 - Cold Storage Rooms13-2148 - Sound-Conditioned Rooms13-3113 - Air-Supported Fabric Structures13-3416 - Grandstands and Bleachers13-3419 - Metal Building Systems13-4900 - Radiation Protection14-2000 - Elevators14-3000 - Escalators and Moving Walks14-4200 - Wheelchair Lifts14-4500 - Vehicle Lifts14-9100 - Facility Chutes14-9200 - Pneumatic Tube Systems21-1300 - Fire-Suppression Sprinkler Systems22-1000 - Plumbing23-0010 - HVAC23-0593 - Testing, Adjusting, and Balancing

for HVAC 23-0900 - Instrumentation and Control for

HVAC 25-0000 - Integrated Automation26-1000 - Electrical Subcontractor

26-3200 - Packaged Generator Assemblies27-0000 - Communications27-1000 - Structured Cabling27-4000 - Audio-Video Communications27-6000 - Wireless Transceivers28-0000 - Electronic Safety and Security28-1300 - Access Control28-2300 - Video Surveillance28-2600 - Electronic Personal Protection

Systems 28-3100 - Fire Detection and Alarm31-0000 - Earth/Sitework31-2500 - Erosion and Sedimentation Controls31-3116 - Termite Control31-6329 - Drilled Concrete Piers and Shafts31-6400 - Caissons32-1216 - Asphalt Paving32-1313 - Concrete Paving32-1316 - Decorative Concrete Paving32-1413 - Precast Concrete Unit Paving32-1600 - Curbs, Gutters, Sidewalks, and

Driveways 32-1613 - Curbs and Gutters32-1623 - Sidewalks32-1713 - Parking Bumpers32-1723 - Pavement Markings32-1816 - Synthetic Resilient Surfacing32-1823 - Athletic Surfacing32-3113 - Chain Link Fences and Gates32-3119 - Decorative Metal Fences and Gates32-3213 - Cast-in-Place Concrete Retaining

Walls 32-3223 - Segmental Retaining Walls32-8423 - Underground Sprinklers32-9223 - Sodding32-9323 - Plants and Bulbs33-0000 - Utilities33-4913 - Storm Drainage Manholes, Frames,

and Covers 33-4923 - Storm Drainage Water Retention

Structures 34-4113 - Traffic Signals34-7113 - Vehicle Barriers41-2200 - Cranes and Hoists


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Regions of Work

AL-Alabama AR-Batesville AR-Camden AR-Fayetteville AR-Fort Smith AR-Harrison AR-Hot Springs AR-Jonesboro AR-Little Rock AR-Pine Bluff AR-Russellville AR-Texarkana AR-West Memphis AZ-Arizona CA-California CO-Colorado CT-Connecticut DC-Washington D.C.DE-DelawareFL-FloridaGA-GeorgiaIA-IowaID-IdahoIL-IllinoisIN-IndianaKS-BellevilleKS-ColbyKS-Dodge CityKS-EmporiaKS-Fort ScottKS-HaysKS-HutchinsonKS-IndependenceKS-Kansas CityKS-Liberal

KS-Salina KS-Topeka KS-Wichita KY-Kentucky LA-Louisiana MA-Massachusetts MD-MarylandME-MaineMI-MichiganMN-MinnesotaMO-Bowling GreenMO-Cape GirardeauMO-ChillicotheMO-ColumbiaMO-Flat RiverMO-HannibalMO-HarrisonvilleMO-Jefferson CityMO-JoplinMO-Kansas CityMO-KirksvilleMO-Poplar BluffMO-RollaMO-SedaliaMO-SikestonMO-SpringfieldMO-St. JosephMO-St. LouisMS-MississippiMT-MontanaNC-North CarolinaND-North DakotaNE-NebraskaNH-New HampshireNJ-New Jersey

NM-New Mexico NV-Nevada NY-New York OH-Ohio OK-Ardmore OK-Clinton OK-Durant OK-Enid OK-Guymon OK-Lawton OK-McAlester OK-Miami OK-Muskogee OK-Oklahoma City OK-Ponca City OK-Poteau OK-Shawnee OK-Tulsa OK-Woodward OR-Oregon PA-Pennsylvania RI-Rhode Island SC-South Carolina SD-South Dakota TN-Tennessee TX-Texas UT-Utah VA-Virginia VT-Vermont WA-Washington WI-Wisconsin WV-West Virginia WY-Wyoming


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Certifications

Type of Labor Classifications Bonding and Insurance

Open Shop

Union

National Agreement

Local Union Agreement

Prevailing Wage

Other Labor Type

Other Labor Type:

Union Information:

WBE – Women-owned

MBE – Minority

DBE – Disadvantaged

VBE – Veteran

SBE – Small Business

State Classification

Federal Classification

Other Classification

Other Class Description:

Classification Certified By:

Are you Bondable? Yes No

Bonding Company:

Bonding Company Tel:

Bond Limit - Single Project

Bond Limit - Aggregate

Bond Rate (If tiered, list all tiers)

Insurance Contact:

Insurance Tel:

Insurance Expiration Date

Explain any work that your firm or any affiliated firm has had completed or supported by a surety.

Check if none


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Legal/Financial

Business Type: Years in Business No. of Employees

State of Formation Date Established Dun & Brad No. D & B Rating

Contractor Licenses Banking Contact Information List all trade and professional licenses required to perform your services.

Provide bank contact information as indicated

State – License # and Expiration Date Bank Name

Contact Name

Telephone

Line of Credit

Unused Credit

Expiration Date

Principals Fictitious [Trade or dba] Names List Business Owners and Key Officers Only List any fictitious [trade or dba] names or affiliate

companies under which your firm operates Name - Title, Yrs. in Position


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Litigation Disclosure

1) Explain any suspensions, denials, or revocations of your company’s contractor license. Check if none

2) Explain any petitions for bankruptcy that your firm or any affiliated firm or any of your owners, officers orprincipals has filed.

Check if none

3) Explain any failure to complete or termination for cause that your firm or any other organization with which yourowners, officers or principals were involved with during the past 5 years.

Check if none

4) Explain any judgments, liens, claims, arbitration proceedings, or suits pending/outstanding against your firm or itsowners, officers or principals.

Check if none

5) Explain any lawsuits or requested arbitration or mediation with regard to construction contracts that your firm hasfiled or been the subject of within the past three years.

Check if none


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Work History

Percent of Work as GC: Percent of Work as Sub: Max Contract $ Value: Max Contract (Months)

Annual Volume of Work: Volume Usually Sub’d Out: Lost Work Days Last Yr.: Fatalities Last 5 Yrs.:

Current EMR Year1: Past EMR Year2: Past EMR Year3: OSHA (TCR) Rate:

Emergency Contact: Emergency Phone: Safety Program Contact: Safety Program Phone:

OSHA Citations Last 3 Yrs.

Provide detail of any OSHA citations your company received in the last (3) years.

Date OSHA Citation

Provide detail of any environmental citations your company received within the last three (3) years:

Date Environmental Citation


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Trade References

OWNERS:

Name of Company Contact Phone Number

GENERAL CONTRACTORS:


SUBCONTRACTORS:


SUPPLIERS:



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Contract History/WIP

List the 10 largest projects on which your firm is currently working:

Project Name /Location Client Name Phone Scope of Work Original Value Start Date Finish Date

List the projects completed in the last five (5) years:

Project Name /Location Client Name Phone Scope of Work Original Value Start Date Finish Date


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By executing below, I am acknowledging that Nabholz Construction and the Owner will be relying upon the accuracy of this above information to assist them in determining whether any organization can be selected bidder for individual work categories or combined work categories as established in the bid documents.

I understand the questions above and have answered truthfully and to the best of my knowledge. I further certify that I have signatory authority on behalf of the company.

Name: Title:

Signature: _____________________________________ Date:

Please return the completed Subcontractor Prequalification Questionnaire, along with required documentation (see page one) back to the person who originated it or to one of the following Procurement Coordinators:

Nabholz Construction Services Central RegionRogers, AR Attn: Sherry Glanton 3301 N 2nd Street Rogers, AR 72756 (479) [email protected]

Nabholz Construction Services Central Region Springfield, MO Attn: Janna Smalley 2223 W Sunset St Springfield, MO 65807(417) [email protected]

Nabholz Construction Services South RegionConway, ARFort Smith, AR Jonesboro, AR Little Rock, AR Olive Branch, MS Attn: Sarah McMillian 612 Garland Street Conway, AR 72032 (501) [email protected]

Nabholz Construction Services Midwest RegionLenexa, KSAttn: Jamie Lancaster17300 W 116th St.Lenexa, KS 66219(913) [email protected]

Nabholz Construction Services Southwest RegionTulsa, OK Attn: Deanna Bowman10319 East 54th Street Tulsa, OK 74146 (918) [email protected]

Nabholz Construction Services Southwest Region Oklahoma City, OK Attn: Cheryl Lowe 6400 South Superior Ave. Oklahoma City, OK 73149 (405) [email protected]


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mailto:[email protected]








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