New subcontractors and vendors please fill out and submit the information requested below.

Date of response
Date of response
Address
Address
Phone
Phone
Is your company:
Address of parent company
Address of parent company
Trades
Date of incorporation
Date of incorporation
Expiration date
Expiration date
List the corporate officers, partners, proprietors, members and shareholders of more than 5% of the stock of your company:
Name, DOB, and percentage owned
Name, DOB, and percentage owned
Name, DOB, and percentage owned
Name, DOB, and percentage owned
Name, DOB, and percentage owned
How many people does your Company presently employ:
How many people does your Company employ pm average for the last 3 years:
List Unions which you have agreements with:
Check all building types on which your Company has worked: *
(Amount - Year - Project name & scope)
(Amount - Project Name & Scope)
( $$$$ & Number of Projects)
Please list all 5 separated by commas
MBE% / WBE %
Min% / Fem%
Bank Address
Bank Address
Bank phone number
Bank phone number
Expiration Date:
Expiration Date:
Date of rating:
Date of rating:
Bonding Company
Surety / key contact person phone number
Surety / key contact person phone number
$
$
Date of last bond
Date of last bond
%
$
List three of your major suppliers:
Supplier address:
Supplier address:
Supplier Contact
Supplier Contact
Supplier phone
Supplier phone
Supplier address:
Supplier address:
Supplier Contact
Supplier Contact
Supplier phone:
Supplier phone:
Supplier address:
Supplier address:
Supplier contact:
Supplier contact:
Supplier phone:
Supplier phone:
List three contractors that you do business with:
Address: *
Address:
Contact 1: *
Contact 1:
Phone: *
Phone:
Address: *
Address:
Contact 2: *
Contact 2:
Phone: *
Phone:
Address: *
Address:
Contact 3: *
Contact 3:
Phone: *
Phone:
List any subsidiaries and affiliates of your Company:
We have attempted to answer all questions in full and complete manner to assure that our answers are not in any respect misleading, either by expressing ourselves in a misleading or ambiguous manner or omitting information. We recognize that MK Group will be relying on the accuracy of the information and our responses in this questionnaire in deciding whether to permit us to bid and in awarding work to our Company.
Date *
Date
Completed by: *
Completed by:
(must be an officer of the Company)
being duly sworn, deposes and says that the information provided herein is true and sufficiently complete so as to not be misleading.
If yes, please check which are included in the policy:
Do you require documented safety meetings for your employees? Indicate which, and how often.
The undersigned warrants and represents the data provided is accurate in all respects.
Prepared by *
Prepared by
Date *
Date
Subcontractor Prequalification Insurance Questionnaire
Contact
Contact
Phone
Phone
A. Commercial General Liability
3. Limits -- input "$Current / $Max Obtainable"
$
B. Excess Liability Insurance Carrier:
C. Worker’s Compensation and Employer’s Liability Insurance Carrier:
D. Automobile Liability Insurance Carrier:
E. Professional Liability Insurance Insurance Carrier:
$
$
(Years)
Please submit proof of insurances, licenses, miscellaneous certificates, qualification statement and portfolio to info@wellbuiltco.com