Please fill this form out completely and attach all required documentation. You may CREATE A FREE ACCOUNT so that you can save your form and return later to complete if you need time to gather your information. Creating an account will also allow you to update your information at a later date.

Prequalication Status: *

PREQUALIFICATION STATEMENT

Company Type (Please Check One*

REGIONS OF WORK

Please check all that apply: *
 

TYPES OF WORK

Please check all that apply: *
 

TRADES OF WORK

Please check all that apply and include a detail of your scope of work below: *

WORK HISTORY


Bozzuto Projects
 12345
Please list any Bozzuto Group projects you have worked on in the last 3 years:


REFERENCES


FINANCIAL


Provided is a formal letter from your insurance company stating your bonding requirements and capacity. *
 

We have submitted a copy of our company's most recent audited financial statements and the most recent internal financial statements to dschorr@bozzuto.com*

LEGAL

Is your company or any of its owners or officers currently involved in any litigation, mediation, arbitration or prosecution or defense of formal claims in connection with any contract, project or subcontract? *
 
Has your company or any affiliated company or any of its principals ever petitioned for bankruptcy, failed in business, closed a business, defaulted or failed to complete on a contract, or been asked to post collateral against a loss? *
 

CONTRACTUAL

I have read the above Sample Subcontract Agreement.   I understand that this document is for informational purposes only
and is not an offer to hire. *
 

SAFETY

Experience Modifier Rating: *
 201520162017
Please provide your company’s EMR for the last three (3) years

Accident and Illness Statistics:

1. How many man-hours has your company worked in each of the last three (3) years?
2. How many OSHA Recordable Injuries did your company experience in each of the last three (3) years?
3. How many Lost Time incidents/days away from work incidents has your company had in each of the last three (3) years?
4. How many Fatalities has your company experienced in each of the last three (3) years?

OSHA Citations: Has your company had a federal or state OSHA Citation within the last three (3) years? *
“If Yes, how many of the following types of citations, if any, have you received?”
 201520162017
Willful
Serious
Other than Serious

CERTIFICATIONS AND LICENCES

Labor Type: please check one *
Certifications: check all that apply
 
Licenses:
 JurisdictionLicense No.
1
2
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5

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