Subcontractor Prequalification Form Company InformationCompany Name: Business Type: LLC INC Sole Prop. General Email: Years in Business: Office Phone:Office Fax: Address: Travel Radius (Miles): Trades Performed: Annual Revenue: $0‐$200k $200k‐$500k $500k‐$1m $1m‐$3m $3m‐$5m $5m + Insurance: License Type and #: Workman’s Compensation: Yes No ReferencesProvide the Last (3) Projects Completed1. Project Name Project Type General Contractor Contact Person (GC) Phone NumberValue of Work Completion Date Month Day Year 2. Project Name Project Type General Contractor Contact Person (GC) Phone NumberValue of Work Completion Date Month Day Year 3. Project Name Project Type General Contractor Contact Person (GC) Phone NumberValue of Work Completion Date Month Day Year Primary ContactContact Name: Title/Position: Specific Email: Cell Phone:
