Name of Firm:_______________________________________ Page 1 of 4 Form Rev. 20160217 New Line Structures 512 7 th Avenue 6 th Floor New York, NY 10018 Tel (212) 280-3019 SUBCONTRACTOR PREQUALIFICATION FORM – PART A (GENERAL INFO) To assist in our review of your company’s qualifications to provide construction services on our projects, please provide the information requested below, and return it to us as soon as possible. Please send unsolicited forms to [email protected]; otherwise, this form (Part A) should be returned directly to the New Line Structures individual who requested it with a cc: to [email protected]. There is a blank page at the end of this document should you need additional space to write down your responses. Thank you and please do not hesitate to contact us with any questions or comments. Both Parts A and B must be returned to New Line Structures to complete the prequalification application. A1. Business Information a. Exact Legal Name of Firm, incl. DBAs: b. Type of Work Performed (also please fill out the attached Trade checklist): c. Contact Name: d. E-mail Address: e. Firm Address: f. Phone: g. Fax: h. State of Incorporation: i. Year Started: j. Tax ID: k. Contractor License #: l. Type of Business i.e. C-Corp, LLC: m. Whether business is a MBE/WBE/SBE/DBE/US8(a) status: n. List any subsidiaries, affiliates or parents: A2. Officer Information a. List the corporate officers, partners, or proprietors of your firm: b. Describe the role and tenure of the above list with the company: c. Please describe whether there have been any changes to the company or structure within the past 5 years. If so, provide details:
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Name of Firm:_______________________________________ Page 1 of 4 Form Rev. 20160217
New Line Structures 512 7th Avenue 6th Floor New York, NY 10018 Tel (212) 280-3019
SUBCONTRACTOR
PREQUALIFICATION FORM –
PART A (GENERAL INFO)
To assist in our review of your company’s qualifications to provide construction services on
our projects, please provide the information requested below, and return it to us as soon as
possible. Please send unsolicited forms to [email protected]; otherwise, this form
(Part A) should be returned directly to the New Line Structures individual who requested it
with a cc: to [email protected]. There is a blank page at the end of this document
should you need additional space to write down your responses.
Thank you and please do not hesitate to contact us with any questions or comments. Both Parts
A and B must be returned to New Line Structures to complete the prequalification application.
A1. Business Information
a. Exact Legal Name of Firm, incl. DBAs:
b. Type of Work Performed (also please fill out the attached Trade checklist):
c. Contact Name:
d. E-mail Address:
e. Firm Address:
f. Phone:
g. Fax:
h. State of Incorporation:
i. Year Started:
j. Tax ID:
k. Contractor License #:
l. Type of Business i.e. C-Corp, LLC:
m. Whether business is a MBE/WBE/SBE/DBE/US8(a) status:
n. List any subsidiaries, affiliates or parents:
A2. Officer Information
a. List the corporate officers, partners, or proprietors of your firm:
b. Describe the role and tenure of the above list with the company:
c. Please describe whether there have been any changes to the company or structure
b. List five (5) of your major suppliers: Name, Phone Number, Contact
c. List five (5) contractors or clients (i.e. references) that you have worked as do
business with including Name, Phone number and Contact
d. Use copies of the attached “NEW LINE STRUCTURES’ PAST PERFORMANCE
QUESTIONNAIRE” sheet to fill out a form for each of the five references above.
A6. Insurance:
a. List coverages and limits currently in force – as well as expiration dates
b. Workers Comp EMR’s for past 3 years
c. Have you had any OSHA fines or fatalities during the past 3 years
d. Please provide a copy of the past 3 years’ worth of OSHA 300 logs
A7. Legal
a. Does your company have any active claims?
b. Any active liens?
c. Any judgements/suits brought against you?
d. Ever failed to complete any work awarded? If yes, explain:
e. Filed any lawsuits or requested arbitration/mediation within the last 3 years?
A8. Operations
a. Do you have an in-house engineering department?
b. List your BIM capabilities:
c. Do you have a full time Safety rep?
d. Does this person perform safety inspections at all your projects?
e. Do you have a written Safety program?
f. Do you have a full time Quality rep?
g. Do you have a written QAQC program?
Name of Firm:_______________________________________ Page 4 of 4 Form Rev. 20160217
New Line Structures 512 7th Avenue 6th Floor New York, NY 10018 Tel (212) 280-3019
SUBCONTRACTOR
PREQUALIFICATION FORM –
PART A (GENERAL INFO)
Please use the blank space below to complete your responses, as needed (reference the item #):
Form Rev. 20160217
New Line Structures 512 7th Avenue 6th Floor New York, NY 10018 Tel (212) 280-3019
SUBCONTRACTOR
PREQUALIFICATION FORM –
PART B (FINANCIAL DOCS)
This is Part B of the prequalification application – Financial Documents.
Name of Firm:_______________________________________
B1. Please attach a copy of the last fiscal financial statement including work in progress &
completed contracts schedule including any interim statements
B2. Please attach a copy of the current financial statement for all indemnitors
B3. Please attach a copy of the Bank Line of Credit agreement
B4. Please attach a copy of the Surety capacity letter.
Both Parts A and B must be returned to New Line Structures to complete the prequalification
application. Please send the information requested above in this Form B directly to Sal
Bousleiman, [email protected] with a cc to the company Controller, Maria
Caba, [email protected]. Be assured that the information provided will be kept in
the strictest confidence.
Thank you and please do not hesitate to contact us should you have any questions or concerns.
Sincerely,
Sal Bousleiman, PE, CCP
Project Executive, Director of Project Controls New Line Structures 512 Seventh Ave, 6th Floor, New York, NY 10018 Office: (212) 280-3019, Direct: (646) 571-1175 [email protected]