Vendor Pre-Qualification

SUBCONTRACTOR QUALIFICATION

Instructions:
Thank you for your interest in Eastman, Cooke & Associates, LLC. Matching your competencies with the right opportunities is vital to the success of delivering projects that satisfy our clients. In an effort to better match your expertise we would like to know about your company.

Please take a moment to fill out this form and then click Submit at the bottom. Please allow enough time to complete it entirely, since you will not be able to save and finish later. We would ask that you focus your attention on the very last section where you can fill out any information that you feel can help Eastman, Cooke & Associates, LLC understand how you differentiate your company from other companies.

Company Name

Address

City

State

Zip Code

Contact First Name

Contact Last Name

Phone

Fax

Cell

Email

Website

Date of Incorporation

Number of Employees

Union Affiliation
Non-unionPrevailing WageSupplier/ VendorUnion

Certifications
MBESBEVBEWBE

Geographic Areas Willing to Work

Trades Performed (Control/ Command to select more than one)

Annual Sales Volume 2018

Annual Sales Volume 2019

Does your company have LEED project experience?
YesNo

If yes, please list job name and Client contact:

Key Contact Information

Principal, President or CEO (List Name, Phone, and Email)

Lead Field Supervisor (List Name, Phone, and Email)

Chief Estimator (List Name, Phone, and Email)

Project References

(List 2 most recent projects)

#1 Project Name

#1 Client or CG Name

#1 Work Performed

#1 Contract Amount

#1 Date of Completion

#1 Contact Person

#2 Project Name

#2 Client or CG Name

#2 Work Performed

#2 Contract Amount

#2 Date of Completion

#2 Contact Person

Bank Reference

Name of Bank

Address

City, State, Zip

Contact Name

Contact Phone

Other Info

Experience Modifier Rate 2018

Experience Modifier Rate 2019

Bonding Capacity

OSHA Citations (if any)

DUNN # (if any)

Insurance Certificate (click here for instructions and sample) (please upload)

Other Misc Upload (Please upload brochure or other helpful doc(s))

Any other info (Please provide additional information you may find important for Eastman, Cooke & Associates, LLC)