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Forms testing page

Forms testing pageBarb Smith2021-12-29T23:44:29+00:00

"*" indicates required fields

Subcontractor and Supplier Interest Form

Vendor Information

Legal Name Under Which You Do Business*

DBA*

Address

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

Contact Person's Name*

First

Title*

Email*

Phone Numer*

Fax Number

Website*

Number of Employees:

Full-Time:*

Part-Time:*

Number of Years in Business*

Annual Volume*

Area(s) of Specialty/NAICS Code(s):*

Business Geographical Area(s):*

Is your company certified by the State of Indiana?*

Yes

No

Interested in becoming certified

Are you certified by the City of Indianapolis?*

Yes

No

Interested in becoming certified

Please check all certifications your company holds with the City:

MBE

WBE

VBE

DOBE

VOSB

Please attach a copy of certification(s):

Max. file size: 256 MB.

Does your firm share office space, staff, or equipment with any other company?*

Yes

No

If yes, explain:

Has your firm ever been denied certification, decertified, or graduated from any certification program?*

Yes

No

If yes, explain:

Signatory to Union*

Local #*

Licenses:

License No.*

State

Type:*

License No.

State

Type:

License No.

State

Type:

Bonding:

Project Limit:*

Aggregate Limit:*

Bonding Company:*

A.M. Best Rating*

Broker / Agent*

Phone*

Safety — Current EMR*

As a Subcontractor, I am Interested in providing quotes for the following scopes:

Professional Services Scopes:

Construction Services Scopes:

Please list 3 projects your firm has completed within the last 18 months—include project name, general contractor, contract value, and scope of work.

Project Name*

General Contractor*

Contract Value*

Scope of Work*

Project Name*

General Contractor*

Contract Value*

Scope of Work*

Project Name*

General Contractor*

Contract Value*

Scope of Work*

Please list 3 project references, including company name, contact person, and telephone number:

Company Name*

Contact Person*

Phone Number*

Company Name*

Contact Person*

Phone Number*

Company Name*

Contact Person*

Phone Number*

Minimum Contact Size*

Maximum Contact Size*

Brief Statement of Capabilities*

By entering my name below, I verify that the information provided on this form is accurate.

Signature of applicant:*

Your typed name above serves as your digital signature.

Date*

"*" indicates required fields

Contractor Interest Form

Vendor Information

Legal Name Under Which You Do Business*

DBA*

Owner's Name*

No. of Yrs. in Business*

Contact Person's Name and Title*

Contact Person's Name*

First

Title*

Address

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

Phone Numer*

Email*

Other Contact

Describe services your business provides:*

Is your company certified by the State of Indiana?*

Yes

No

Interested in becoming certified

Are you certified by the City of Indianapolis?*

Yes

No

Interested in becoming certified

Please check all certifications your company holds with the City:

MBE

WBE

VBE

DOBE

VOSB

Please attach a copy of certification(s):

Max. file size: 256 MB.

Area(s) of Specialty/NAICS Code(s):*

Business Geographical Area(s):*

List three (3) of your largest contracts your business completed and their contract amounts within the past four (4) years:

Name of Owner/Contractor*

Phone Number*

Date Started*

Date Completed*

Project Name and Contract Amount*

Name of Owner/Contractor*

Phone Number*

Date Started*

Date Completed*

Project Name and Contract Amount*

Name of Owner/Contractor*

Phone Number*

Date Started*

Date Completed*

Project Name and Contract Amount*

EMR Ratings for the past 3 Years:

Year*

Have you failed to complete a project(s) or have any litigations and/or judgements pending?

Yes

No

If yes, please provide Owner(s) / Contractor(s) and Project names:

Brief Description of Circumstances (if applicable):

As a Subcontractor, I am Interested in providing quotes for the following scopes:

Select from the list below:*

Demolition

Cast-in-Place Concrete

Precast Concrete

Flat-Bed Hauling

Saw-Cutting

Tri-Axle Hauling

Masonry

Structural Steel

Ornamental Railings

General Trades

Casework and Millwork

Metal Panels

Roofing

Exterior Glass & Glazing

Anti-Shatter Film

Interior Glass & Glazing

Drywall, Ceilings, and Paint

Tile, Carpet, and Resilient

Signage

Window Treatments

Elevators & Escalators

Fire Protection

HVAC

Plumbing

Electrical, Power, Lighting

Plaza General Trades

Earth Work

Other Scopes

Please list 3 project references, including company name, contact person, and telephone number:

Company Name*

Contact Person*

Phone Number*

Company Name*

Contact Person*

Phone Number*

Company Name*

Contact Person*

Phone Number*

By entering my name below, I verify that the information provided on this form is accurate.

Signature of applicant:*

Your typed name above serves as your digital signature.

Date*

Title of Applicant*

"*" indicates required fields

Subcontractor and Supplier Interest Form

Vendor Information

Legal Name Under Which You Do Business*

DBA*

Address

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

Contact Person's Name*

First

Title*

Email*

Phone Numer*

Fax Number

Website*

Number of Employees:

Full-Time:*

Part-Time:*

Number of Years in Business*

Annual Volume*

Area(s) of Specialty/NAICS Code(s):*

Business Geographical Area(s):*

Is your company certified by the State of Indiana?*

Yes

No

Interested in becoming certified

Are you certified by the City of Indianapolis?*

Yes

No

Interested in becoming certified

Please check all certifications your company holds with the City:

MBE

WBE

VBE

DOBE

VOSB

Please attach a copy of certification(s):

Max. file size: 256 MB.

As a Subcontractor, I am Interested in providing quotes for the following scopes:

Professional Services Scopes:

Construction Services Scopes:

By entering my name below, I verify that the information provided on this form is accurate.

Signature of applicant:*

Your typed name above serves as your digital signature.

Date*

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Corporate Office

3925 E. 26th Street
Indianapolis, IN 46218
(317) 545-4285
info@nubianconstructiongroup.com