Subqualification Form

Name of Company *
Main Business Address
City
Zip Code
State
Phone Number
Fax Number
Type of Work/Service
Organization Type/Tax Entity (Sole proprietor, partnership, incorporation, etc)

Company Representative/Contact
Title
Telephone Number
Cellular Phone Number
Other Phone Number (Nextel,etc.)

Secondary Company Representative/Contact
Title
Telephone Number
Cellular Phone Number
Other Phone Number (Nextel,etc.)
Company History
Names and titles of all responsible parties affiliated with your company
List other/previous company names
Years in business under other names
Previous company tax identification number (if applicable)
List all business licenses held by your company
List all contracting licenses held by company
Years in business under existing name
Number of office employees/ personnel
Number of field employees/ personnel
Financial and Insurance (all fields required)
Annual volume of business in dollars for the last year *
Annual volume of business in dollars for the last three years *
Annual volume of business in dollars for the last five years *
Insurance Company *
Insurance Company Contact/Phone Number *
Types and amounts of insurance coverage * Hathaway minimum requirements $1,000,000.00 GL & $1,000,000.00 WC
Worker's Compensation Insurance Co./ Phone Number/ Contact *
Does your company have an organized safety program meeting OSHA standards? *
Has your company been cited by OSHA or another regulating agency for safety violations? *
If yes, please explain
Bank Affiliation *
Number of Years *
Bank Contact *
Bank Phone Number *
Are You Bondable?
If you answered yes:
Name of Bonding Company
Bonding Company Contact
Bonding Company Phone Number
Can you provide a labor and material bond and performance bond?
What are your bonding limits and rates?
By submitting this form you warrant that all of the above information is correct and accurate to the best of your knowledge and that you have the authority to release the above information to Hathaway Construction. In addition, you and your company give permission to Hathaway Construction to perform a credit check and verify any of the above information and contact any of the above entities for verification and accuracy of the information supplied.

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