SUBCONTRACTOR PRE-QUALIFICATION FORM

Non Disclosure Information

  1. In consideration of the Prequalification Applicant’s willingness to disclose its Confidential Information to the William Chares Companies, and the William Charles Companies’ disclosure of Confidential Information related to construction projects the party receiving Confidential Information (the “Recipient”) agrees to maintain the Confidential Information in confidence and not to disclose it to anyone else, nor use it for Recipient’s own benefit or for the benefit of others without the Disclosing party’s prior written consent. Recipient agrees to limit the disclosure of the Confidential Information to those internal persons and outside advisors who have a need to know such Confidential Information and only to such of those persons who agree to be bound by the terms of this Non Disclosure Restriction. Recipient indemnifies the Disclosing Party for any misuse of the Confidential Information by any person or entity to whom Recipient has disclosed the Confidential Information.

 

  1. For the purposes of this Restriction, Confidential Information shall include, but not be limited to, technical data (e.g. computer software, drawings, processes, hardware, firmware), business and financial information, correspondence, written or oral representations, memoranda, reports, records, or other such conveyance of information which is proprietary and held confidential by the disclosing party and identified in the Prequalification form or identified by the Disclosing Party. However, Confidential Information shall not include any information: (a) which was known or used by Recipient prior to the date of such disclosure as evidenced by Recipient’s written records; or, (b) which is in the public domain; or, (c) which has legally come into Recipient’s possession through channels independent of the Disclosing Party; or, (d) which is required by law or legal process to be disclosed.

 

  1. The term of this Restriction shall commence on the date the Prequalification Applicant submits its Prequalification to the William Charles Companies and shall be in full force and effect for a period of three (3) years. If the Prequalification applicant is not selected to perform work for the William Charles Companies this Confidentiality Restriction shall survive and shall be binding upon the parties for a period of two years from the date of disclosure of any Confidential Information.

 

  1. Any and all documents produced or delivered by one party to the other party shall remain the property of the Disclosing Party, and all such documents and all copies thereof shall be promptly returned to the delivering party upon demand. If the Recipient is served with a subpoena or other document or directive containing the force of law requiring disclosure of Confidential Information, the Recipient shall immediately disclose the subpoena or other document or directive to the Disclosing Party so that the Disclosing Party shall have sufficient opportunity to, if it so chooses, contest the subpoena or other document or directive.

Company Contact Information

Please select the company for which you wish to qualify *
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Company History

Please select type of business. *
Please select company type. *
 

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Has Your Firm Done Business Under A Different Name? *
 
Has Your Firm Ever Failed To Complete Any Work Awarded Within The Last 5 Years *
Are you qualified as a contractor under the U.S. government System for Award Management (SAM) process? If so, please provide any certification or registration number applicable to www.sam.gov. *
 
Have you ever been debarred or suspended from qualification under the System for Award Management (SAM) process? If so, please explain details including date, reason, terms of suspension, and the date of any reinstatement. *
 
Has Your Current Firm Or Any Predecessor Organization Been Involved In Any Litigation, Arbitration or Legal Dispute With An Owner, Architect, Or General Contractor Within The Last 5 Years? *

Annual Dollar Volume
 Dollar Amount
2021
2020
2019
2018
2017
Name Of Company Officers, Principals, Partners, Or Owners (Please Include Name and Title)
 NameTitle
Name 1
Name 2
Name 3
Name 4
Name 5
Current # Of Employees
 #
Office
Field

Work History


Bidding Information

Type Of Projects Your Company Specializes In (Please Check All Applicable Types) *
 
Preferred Job Cost Range *
Please select all states where your company is willing and able to work. *
Please List Work Types Normally Performed By Your Own Forces
 Work Type
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7.
Please List Work Usually Subcontracted Out To Others
 Work Type
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Safety

Does Your Company Have: (Please Check All Applicable Items) *
Has Your Company Implemented 100% Fall Protection at 6 Feet and Above *
Has Your Company Ever Received A Willful OSHA Citation? *
Please List your Firms Experience Modification Rate (EMR)
 EMR
2021
2020
2019
2018
2017
Please List your Firms Recordable Incident Rate (RIR)
 RIR
2021
2020
2019
2018
2017
Please List your Firms Number of OSHA Recordables
 OSHA
2021
2020
2019
2018
2017

Bonding

Surety Company Address

Insurance

Insurance Carrier Address

Financial


Please Provide Your Banking Instutition Contact Information
Have you ever been debarred or suspended by any government agency?
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EEO

Do you have a designated EEO Officer? *
Does your company utilize E-Verify to confirm that their employees are legally permitted to work in the U *

Disadvantaged, Minority, Woman, Small & Veteran Business Enterprise (DBE/MBE/WBE/SBE/VBE)

49 CFR Part 26, stipulates that every DBE must perform a Commercially Useful Function, this means DBEs must be responsible for the management and supervision of the entire scope of work on a particular contract, own their equipment, pay their employee and show independency from a non-DBE contractor. Non - DBE Contractors planning to use DBEs must comply with provision 49 CFR Part 26 which regulates DBE participation on public contracts.

Is Your Firm Certified As Any of The Following (Please Check All That Apply) *
 
Is the company qualified by any agency to perform work as Disadvantaged, Minority, Woman, Small or Veteran Business Enterprise (DBE/MBE/WBE/SBE/VBE)? *
In which NACIS or UCP codes are you certified as a DBE / VBE?
 NAICS/UCP CodeAuthorizing Agency
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Please attach a PDF of your most recent DBE/MBE/WBE /VBE Certification, “No Change Affidavit Approval” or "Continued DBE Eligibility Affidavit", etc.