TRADE PARTNER PREQUALIFICATION STATEMENT

"*" indicates required fields

Please note: All fields are required. If a field does not apply to you, please enter in NA. If a numeric field does not apply to you, please enter the number 0.

SUBMITTED BY

Company Name*

Date*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Enter Email Confirm Email

Principal Office*

Primary Scope of Work*

Secondary Scope of Work*

Division Manager Name*

Division Manager Phone*

Division Manager Email*

Project Manager Name*

Project Manager Phone*

Project Manager Email*

Preconstruction Name*

Preconstruction Phone*

Preconstruction Email*

Accounting Dept. Name*

Accounting Dept. Phone*

Accounting Dept. Email*

ORGANIZATION

How many years has your organization been in business?*

How many years has your organization been in business under its present business name?*

Please list all Landlords or Buildings that your organization is listed as a required / preferred vendor*

Please click the plus (+) icon to add items.

Total Number of Employees*

Office / Admin*

Field Supervisors*

Field Labor*

Please list typical contract value ($) of projects completed*

Please list average job size (SF) of projects where you have been most successful delivering quality and on schedule*

[Entire section above complete = 5 points, Incomplete = 0 ]

Please state distance from Center City Charlotte where you would consider completing projects*

[ Every 60 miles = 1 point(Max of 6 points) ]

LICENSING & CERTIFICATIONS

Provide licensing information for the following states:

North Carolina Contractor’s License #*

South Carolina Contractor’s License #*

Is your organization currently certified as a HUB (Historically Under-Utilized Business), Veteran Owned or MWSBE?*

Yes

Yes = 5 points / Certification attached = 5 points (Max of 10 points) ]

If yes, select applicable certification**

Please attach supporting documentation

Max. file size: 256 MB.

How does your firm plan to provide MWSBE participation on your project? (if non-diverse vendor)*

[ Explanation provided = 5 points ]

Are members of your organization CEWA certified?*

Yes

[ Yes = 1 point, No = 0 points ]

EXPERIENCE

Has your organization ever failed to complete an awarded scope of work?*

Yes

If so, provide a written statement of explanation*

[ Yes = 0 points, No = 5 points ]

Are there any judgements, claims, arbitrations, proceedings, or suits pending or outstanding against your organization?*

Yes

If so, provide a written statement of explanation*

[ Yes = 0 points, No = 5 points ]

Does your organization subcontract work to others?*

Yes

[ Yes = 0 points, No = 1 point ]

Does your organization have a service department?*

Yes

[ Yes = 1 point, No = 0 points ]

Do you have 24-hour coverage?*

Yes

[ Yes = 1 point, No = 0 points ]

Does your organization have experience with LEED projects?*

Yes

[ Yes = 1 point, No = 0 points ]

FINANCIALS

List the annual dollar value of construction work the company has performed for each year over the last (3) calendar years.

Year*

Amount*

Year*

Amount*

Year*

[ Each year completed = 1 point (Max of 3 points) ]

Amount*

[ Each year completed = 1 point (Max of 3 points) ]

Expected annual volume (current year)*

[ 1 point ]

Provide your Dunn & Bradstreet rating if one exists*

Please list the total number of projects you currently have under contract or in progress and their total dollar value?

[ Entire section below completed = 3 points, Incomplete = 0 points ]

# of Projects*

Current Projects Total Contract Amount*

Current Projects Amount Remaining to Bill*

What is your largest job completed (SqFt)?*

Dollar Value*

[3 points]

What is your current Backlog?*

[3 points]

If requested, are you willing to provide financial information?*

Yes

[ Yes = 6 points, No = 0 points ]

If yes, please indicate the format in which your financials will be submitted?*

Hard Copy

Virtual Presentation

Financial Information

Max. file size: 256 MB.

List the (3) three largest projects your organization has in progress

[ Each project = 2 points (Max of 6 points) ]

Project 1

Project Name*

Anticipated date of completion*

Client*

Percentage of work performed with your own workforce*

Architect*

Contract Value*

Project 2

Project Name*

Anticipated date of completion*

Client*

Percentage of work performed with your own workforce*

Architect*

Contract Value*

Project 3

Project Name*

Anticipated date of completion*

Client*

Percentage of work performed with your own workforce*

Architect*

Contract Value*

SAFETY

Does your organization have a written Environmental Health and Safety Program?*

Yes

If so, provide a copy

Max. file size: 256 MB.

[ Yes (with copy attached) = 1 point, No = 0 points ]

Identify the person within your organization directly responsible for Safety Program Management

Name*

Phone*

Email*

Has your firm had any OSHA violations within the most recent three (3) years?*

Yes

If yes, please provide a written statement of explanation

Max. file size: 256 MB.

[Yes = 0 points, Yes (with statement of explanation) = 2 points, No = 4 points]

What is your company’s total incident case rate?*

What is your company’s EMR?*

[ TICR: less or equal to 2.7 = 10 points. Greater than 2.7, 0-10 points pending additional documentation. ]
[ EMR: less or equal to 1.0 = 5 points. Greater than 1.0, 0-5 points pending additional documentation. ]

BONDING

Bonding Company*

Name of Agent*

Agent Phone*

Agent Address*

Street Address Address Line 2 City State ZIP Code

Surety Letter

Max. file size: 256 MB.

Attach letter, dated within the last 30 days, from your surety company, signed by their Attorney in Fact, to verify their willingness to issue sufficient payment and performance bonds for projects, on behalf of your firm and the dollar limits of that bond commitment, both single and aggregate. Surety company bond rating shall be rated “A” or better under A.M. Best Rating system or the Federal Treasury List.

Have you attached a surety letter?*

Yes

Have any funds been expended by a Surety Company on your firm’s behalf?*

Yes

If yes, please explain:

[ Entire section completed with supporting documentation attached = 10 points, Incomplete = 0 points ]

INSURANCE REQUIREMENTS

1. Workman’s Compensation and Employers Liability					Statutory
2. Commercial General Liability
a. Bodily Injury – Each Person and Occurrence					$1,000,0000
b. Property Damage – Each Occurrence and Aggregate					$1,000,000
c. Combined Single Limit – General Aggregate (per project)					$2,000,000
Products Completed					$2,000,000
3. Comprehensive Automobile Liability
a. Bodily Injury – Each Person and Occurrence					$1,000,000
b. Property Damage – Each Occurrence					$1,000,000
4. Employer’s Liability
a. Each Accident					$500,000
b. Bodily Injury – Each Employee					$500,000
c. Disease – Each Employee					$500,000
d. Policy Limit					$500,000
5. Umbrella / Excess Liability
a. Each Occurrence					$5,000,000
b. Retention					$10,000
c. Annual Aggregate					$5,000,000

General Liability Company*

Name of Agent*

Agent Phone Number*

Agent Address*

Street Address Address Line 2 City State ZIP Code

[ COI attached = 1 point ]

Upload Certificate of Insurance*

Max. file size: 256 MB.

REFERENCES

Please list three professional references:
[ Each reference listed = 2 points (Max of 6 points) ]

Reference 1

Full Name*

Relationship*

Company*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Reference 2

Full Name

Relationship

Company

Phone

Address

Street Address Address Line 2 City State ZIP Code

Reference 3

Full Name

Relationship

Company

Phone

Address

Street Address Address Line 2 City State ZIP Code

BILLING & PAYMENT INFORMATION / NOTICE OF CONTRACT & LEIN WAVERS

The below is a standard list of documents that will be required for payment. Additional documentation may be required at the request of the owner.

A current Certificate of Insurance must be on file prior to processing application for payment.
A signed W-9 must be on file prior to processing application for payment.
Invoice period is from the 16th of the previous month through the 15th of the current month.
Invoices are due to McFarland Construction no later than the 15th of the current month.
Invoice per “Invoice/Pay App Cover Sheet”.
10% Retention will be withheld from each progress invoice.
Prior to the start of work a current COI naming McFarland Construction and the Owner as additional insured must be on file with McFarland Construction. Fulfillment of this obligation is a condition precedent of any obligation of McFarland to remit any payment to the Trade Partner.
Must provide a lien release in the forms attached hereto from the Trade Partner and all lower tier Trade Partners or suppliers to the Trade Partner with each payment request.
Must complete all work and pass all inspections prior to submitting a final invoice.
Must complete any and all closeout requirements prior to the release of retention.

DISCLAIMER AND SIGNATURE

Upload W-9*

Max. file size: 256 MB.

I certify that my answers are true and complete to the best of my knowledge. I understand that false or misleading information on behalf of my organization stated on this prequalification or interview may result in disqualification.*

I certify that my answers are true and complete to the best of my knowledge.
I understand that false or misleading information on behalf of my organization stated on this prequalification or interview may result in disqualification.

Signature*

[ Prequalification form signed and dated = 2 points ]

Date*