Subcontractors - Wieland

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Step 1 of 11 – Subcontractor Qualification Form

Subcontractor Qualification Form

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This field is for validation purposes and should be left unchanged.

Complete the following to begin the application process. The application will save information as you enter it, and you can close at anytime. Follow the link in your email to return and complete your application.

Legal Company Name*

Email Address*

Enter Email Verify Email Address

Zip Code*

Complete the following to continue the application process. The application will save information as you enter it, and you can close at anytime. Follow the link in your email to return and complete your application.

All information must be completed in order to be considered for pre-qualification. In the event that a specific field does not pertain to your particular business or trade, please enter “N/A”.
– Please return completed form, along with a current financial statement
– Your progress is being automatically saved as you fill out this form

Legal Company Name*

Principal's Name*

Estimator's Name*

Company Street Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone #*

Fax #

E-mail Address*

Federal Id #*

Type of Business:*

Corporation

Individual

Partnership

Joint Venture

Other

Work Division:*

(Choose up to 5)

Is your company currently bidding a specific WIELAND project?*

Yes

This field is hidden when viewing the form

(if Yes, Provide Project Name. If No, Enter N/a)

Your Firm is:

Union

Non-Union

Disadvantaged Business Enterprise (DBE)

Minority Business Enterprise (MBE)

Women Business Enterprise (WBE)

Other:

(Please check all that apply.)

1. How many years has your organization been in business as a Subcontractor/Supplier?*

2. How many years has your organization been in business under its present business name?*

3. Under what other names or former entities has your organization previously operated?*

You must complete at least one of the following (4-7)

4. If your organization is a corporation, answer the following:

A. Date Of Incorporation

B. State Of Incorporation

C. President's Name

6. If your organization is individually owned, answer the following:

B. Type Of Partnership

A. Date Of Organization

C.name(s) Of General Partner(s)

5. If your organization is a partnership, answer the following:

A. Date Of Organization

B. Name Of Owner

1. Contractor’s Proposed Field Organization (provide office and field contacts & responsibilities)

Project Manager*

Field Operations Manager*

Superintendent*

Safety Representative*

Accounting Manager*

Shop Drawings/submittal Coordinators*

2. Does your company have documented procedures for ensuring total document control, monitoring daily progress and activities, employee training, etc.?*

Yes

3. Does your company understand Wieland Corporation's safety policy and agree to comply with ALL identified requirements?*

Yes

4. Has your company been assessed Liquidated Damages in the past 5 years? (If so, please explain)*

Yes

Please Explain*

5. Has your company been involved in litigation related to performance of a contract in the past 5 years? (If yes, please explain)*

Yes

Please Explain*

6. Has your company, any corporate officer (past or present), or any previous operating entity declared bankruptcy in the past 5 years? (If yes, please explain)*

Yes

Please Explain*

1. List jurisdiction and trade categories in which your organization is legally qualified to do business, and indicate registration or license numbers, if applicable*

2. List the categories of work that your organization normally performs with its own forces. Please include major CSI Category/CSI Code when applicable.*

3. List three (3) major construction projects your organization currently has in progress, provide the name of the project, Owner and/or CM/GC, Architect, contract amount, percent complete and scheduled completion date. Please complete the following fields in their entirety.

Project 1

Project Name*

Contract Value*

Percent (%) Complete*

Anticipated Date Of Completion*

Owner Or Cm/gc Name*

Owner Or Cm/gc Phone #*

Architect Name*

Architect Phone #*

Project 2

Project Name*

Contract Value*

Percent (%) Complete*

Anticipated Date Of Completion*

Owner Or Cm/gc Name*

Owner Or Cm/gc Phone #*

Architect Name*

Architect Phone #*

Project 3

Project Name*

Contract Value*

Percent (%) Complete*

Anticipated Date Of Completion*

Owner Or Cm/gc Name*

Owner Or Cm/gc Phone #*

Architect Name*

Architect Phone #*

4. List three (3) major projects your organization has completed in the past two years; provide the name of the project, Owner and/or CM/GC, Architect, contract amount and date of completion. Please complete the following fields in their entirety.

Project 1

Project Name*

Contract Value*

Date Of Completion*

MM slash DD slash YYYY

Owner Or Cm/gc Name*

Owner Or Cm/gc Phone #*

Architect Name*

Architect Phone #*

Project 2

Project Name*

Contract Value*

Date Of Completion*

MM slash DD slash YYYY

Owner Or Cm/gc Name*

Owner Or Cm/gc Phone #*

Architect Name*

Architect Phone #*

Project 3

Project Name*

Contract Value*

Date Of Completion*

MM slash DD slash YYYY

Owner Or Cm/gc Name*

Owner Or Cm/gc Phone #*

Architect Name*

Architect Phone #*

1. Vendor/Supplier References: (Please list 3 as required)

Contact Name (company Name)*

Phone*

Email*

Contact Name (company Name)*

Phone*

Email*

Contact Name (company Name)*

Phone*

Email*

2. Bank References:

Bank Name*

Contact Name*

Phone*

Email*

3. Owner/General Contractor References: (Please list 3 as required)

Contact Name (company Name)*

Phone*

Email*

Contact Name (company Name)*

Phone*

Email*

Contact Name (company Name)*

Phone*

Email*

4. Surety:

Name Of Bonding Company*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Bonding Capacity*

Name Of Agent*

Phone*

Email*

1. Does your firm currently have a written quality plan and/or documented quality control/procedure?*

Yes

2. Does your firm currently have a designated Quality Control Inspector? (If yes, please provide name and contact info of QC Inspector)*

Yes

Please provide name and contact info of QC Inspector*

1. Does your firm currently have a documented EMR, Safety Program, and OSHA 300 Form?*

Yes

If yes, enter EMR Rating:

Safety Program*

Yes

OSHA 300 Form*

Yes

2. Does your firm have an active drug test policy? (Selected contractors will be required to provide current proof of drug testing prior to consideration of awarding contract)

Yes

1. Please indicate the median contract value for your company.*

$0 – $100,000 Contract Value

$100,001 – $500,000 Contract Value

$500,001 – $1,000,000 Contract Value

$1,000,001 – $5,000,000 Contract Value

$5,000,001 – $20,000,000 Contract Value

Please indicate if you have a preference of the size project you are interested in.*

2. Please indicate in which states/jurisdictions your firm is interested in bidding.*

Untitled

1. Mark-up allowed for additional work (Change Orders) Per Contract Documents*

Yes

N/A

Typical mark-up on self-performed work (%)*

Typical mark-up on Subcontractor performed work (%)*

Typical credit for Contract Deductions (Eliminated Scope) (%)*

1. On average, what percentage of your total job cost is direct labor?*

2. On average, what percentage of your total job costs is material only?*

3. On average, what percentage of your total cost is committed to subcontract work, i.e. material not directly procured and labor not directly employed by your company?*

4. Please indicate how many persons you employ and provide a regional breakdown in operating in multiple jurisdictions.

Please provide the following supplemental documentation with your completed form:

1. Submit not less than one of the following three items:

– – Audited Financial Statement from previous fiscal year
– – Federal Tax Return from previous fiscal year
– – Letter of Surety stating years of associated with bonding/surety company and per project dollar limit and company aggregate dollar limit. Signed Attny-in-Fact OR Power of Attorney.

2. W-9 Taxpayer ID Certificate signed and dated

3. Certificate of Insurance and required endorsements showing coverage in General Liability, Automobile, and Umbrella.

4. Workers Comp Certificate in Michigan and other states. Territories or jurisdictions as required by statue of regulation. May be included with Certificate of Insurance.

5. Company Safety Program:

– – Provide companywide EMR Factor for past three calendar years.
– – Provide copies of OSHA 300-A logs for past three calender years.
– – Provide records of M.U.S.T. Training Certificate.
– – Provide copies of OSHA 10 Hour and 30 Hour Certifications.

6. Company Quality Action/Quality Control Policy:

– – Submit Formal QA/QC Policy Documentation for Review

Upload Document Form Here*

Accepted file types: pdf, doc, txt, rtf, docx, Max. file size: 50 MB.

I,*

certify that the information herein is true and sufficiently complete as not to be misleading.

Date*

MM slash DD slash YYYY

Title:*

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