All subcontractors are required to complete this form. The contents of this form will be considered
confidential and used solely to determine your firm’s qualifications, and will not be disclosed to the
project staff. Please email this completed form, to tom@houserennerconst.com or fax to (816) 229-0486
GENERAL INFORMATION
Legal Name of Business:
Street Address, City, State, Zip:
Mailing Address, City, State, Zip:
Phone 1:/ Phone 2:/ Fax:
Primary Contact			Billing Contact
Administrative Contact:			Other Contact:
Contractors License Number:			State:
Contractors License Number:			State:
ORGANIZATION
Please indicate your firm’s legal structure:		[    ]       C Corporation	[    ]       S Corporation	[    ]   Partnership
		[    ]      Sole Proprietor	[    ]     Limited Liability Co.
Federal Employer Identification Number:
Principals:
Name:		Title:	Age:	Years in Position:
Name:		Title:	Age:	Years in Position:
Name:		Title:	Age:	Years in Position:
WORK CLASSIFICATION
Please list the type(s) of work you are interested in bidding:
WORK EXPERIENCE
Please attach a list of the major projects your firm currently has in progress showing the project name,
location, owner, architect/engineer, general contractor, contract amount, percent complete and
scheduled completion date, and contact person.
Please attach a list of the major projects your firm has completed in the last three years showing the
project name, location, owner, architect/engineer, general contractor, contract amount and completion
date, and contact person.
FINANCIAL INFORMATION
Please attach your firm’s most current financial statements (audited, if available), for the entity that will
be signing the subcontract.
REFERENCES
Bank:			Contact
Telephone			Acct#
Bonding Company			Agent Name
Address: Phone:			Phone
Bonding Capacity: $ Per Project:			Aggregate $
Date, amount, and type of last bond issued:
Bond Rate: $
Vendor/Supplier Reference			Contact Person
Vendor Phone Number
SUBCONTRACTOR PROFILE
Current Number of office employees:			Field Employees
Does your firm operate as a Union shop?		Yes   No	Merit Shop?	Yes    No
SAFETY, HEALTH, AND ENVIRONMENTAL
Workers Compensation Modification Rate:
Does your company have a written safety program?      Yes     No
INSURANCE
SEE SAMPLE FOR REQUIREMENTS
ADDITIONAL INFORMATION
Please list any additional information that you feel will help us determine your firm’s qualifications and expertise:
This Subcontractor Pre-qualification was completed by:
Name:
Title:
Date