Subcontractor Pre-qualification Statement By submitting this Statement, Subcontractor affirms that the information provided herein is true and sufficiently complete so as not to be misleading. All fields must be completed in order to be processed by CK Construction Corp. Failure to complete all fields may result in a nonprequalification of your firm. PROJECT NAME: SUBMITTED TO: ADDRESS: CK Construction Corp. 1981 S. Painter Lane West Haven, Utah 84401 SUBMITTED BY: SUBCONTRACTOR NAME: PHYSICAL ADDRESS: PHONE/ CELL FAX NUMBERS: EMAIL ADDRESS: SECONDARY CONTACT INFORMATION FOR E-BUILDER COORESPONDENCE: NAME: E-MAIL: PHONE/ CELL (Will be used for sending information, bid documents, addenda, bid forms, clarifications, etc.) Minority Business Enterprise Status. MBE WBE DBE (Please attach certificate & check all that apply) Plans Digital or Printed, please check one.
CHECK THE BOXES NEXT TO THE BID PACKAGES FOR WHICH SUBMITTING FIRM WISHES TO PRE-QUALIFY: 2A Earthwork 2B Site Utilities 2C Drilled Piers 3A Foundations 3C Reinforcing Material 3E Slabs, Steps, and Misc 4 Masonry 5 Steel Material 6 Steel Erection 7A Gypsum Board Assemblies 7B EFIS 7C Acoustical Ceilings 8A Roof Insulation 8B Architectural Metal 8C Shingled Roofing 8D Membrane Roofing 9 Doors & Hardware 10 Aluminum Doors, Windows 11A Overhead Doors & Grilles 11B Wood Windows material 11C Unit Skylights 11D Translucent Panels 11E Folding Doors 12 Painting 13A Ceramic Tile Flooring 13B Wood Flooring 13C Resilient Flooring & Carpet 13D Composition Flooring 13E Epoxy Flooring 13F Concrete Stain and Sealant 14A Architectural Casework 14B Laboratory Casework 15 Specialties 16A Prefabricated Partitions 16B Stage Curtain & Rigging 16C Stage Lighting & Sound 16D Laundry Equipment 16E Food Service Equipment 16F Gymnasium Equipment 17A Elevators 17B Lifts 17C Hoists & Cranes 18 Mechanical 19A Electrical 19B Technology 20A Fencing 20B Irrigation Systems 20C Landscaping 21A Asphalt Pavement 21B Site Concrete 22A Pre Fabricated Detention Cells 22B Security Metal & Hardware 22C Security Fencing 22D Security Electronics 23A Asbestos Abatement 23B Building Demolition 23C Precast Concrete 23D Driven Piles 23E Drilled Piers 23F Sprayed Fire Resistive Materials 23G Pre Engineered Buildings 23H Metal Lockers 23J Wood Framing Labor 23K Exterior Bleachers 23L Synthetic Surfaces 24A Playground Surfaces 24B Playground Equipment 24A Playground Surfaces 24B Playground Equipment 24C Pedestrian Bridge 25 Ice Rink Cooling System 26 Crane Equipment 27A Foamed in Place Insulation 27B Cellulose Sprayed Insulation CK Construction Corp.-Subcontractor Pre-qualification Statement Page 2 of 6
1. ORGANIZATION 1.1 How many years has your organization been in business as a Subcontractor? 1.2 How many years has your organization been in business under its present business name? 1.2.1 Under what other or former names has your organization operated? 1.3 If your organization is a corporation, answer the following: 1.3.1 Date of incorporation: 1.3.2 State of incorporation: 1.3.3 President s name: 1.3.4 Vice-president s name(s): 1.3.5 Secretary s name: 1.3.6 Treasurer s name: 1.4 If your organization is a partnership, answer the following: 1.4.1 Date of organization: 1.4.2 Type of partnership (if applicable): 1.4.3 Name(s) of general partner(s): 1.5 If your organization is individually owned, answer the following: 1.5.1 Date of organization: 1.5.2 Name of owner: 1.6 If the form of your organization is other than those listed above, describe it and name the principals: 2. LICENSING 2.1 List jurisdictions and trade categories in which your organization is legally qualified to do business, and indicate registration or license numbers, if applicable. 2.2 List jurisdictions in which your organization s partnership or trade name is filed. Page 3 of 6
3. EXPERIENCE 3.1 List the categories of work that your organization normally performs with its own forces. 3.1.1 What are your Firm s Manpower Capabilities (crews and sizes)? 3.1.2 Please write in which States your company is willing to work. 3.2 Claims and Suits. (If the answer to any of the questions below is yes, please attach details.) 3.2.1 Has your organization ever failed to complete any work awarded to it? 3.2.2 Are there any judgments, claims, arbitration proceedings or suits pending or outstanding against your organization or its officers? 3.2.3 Has your organization filed any law suits or requested arbitration with regard to construction contracts within the last five years? 3.2.4 Has your organization failed to complete its portion of work by the contract completion date within the past five years? 3.2.5 Are there now pending and/or have there ever been Liquidated Damages assessed against your organization? 3.3 Within the last five years, has any officer or principal of your organization ever been an officer or principal of another organization when it failed to complete a construction contract? (If the answer is yes, please attach details.) 3.4 On a separate sheet, list major construction projects your organization has in progress, giving the name of project, phone & fax number for the general contractor and architect, contract amount, percent complete and scheduled completion date. 3.4.1 State total worth of work in progress and under contract: Page 4 of 6
3.5 On a separate sheet, list the major projects your organization has completed in the past five years, giving the name of project, contact information for the general cont ractor and architect, contract amount, date of completion and percentage of the cost of the work performed with your own forces. 3.5.1 State average annual amount of construction work performed during the past five years: 3.6 On a separate sheet, list the construction experience and present commitments of the key individuals of your organization. 3.7 On a separate sheet, list past work history with CK Construction Corp. 4. REFERENCES 4.1 Supplier References (Include contact name, phone & fax number). (minimum of three): General Contractor References (Include contact name and phone number). (minimum of three): 4.2 Banking Reference (Include Contact Name and Phone): 4.3 Surety: 4.3.1 Bonding Company and Information: 4.3.2 Please answer the following questions: Are you able to provide a 100% performance/payment bond? YES NO Are you able to provide a bid bond? YES NO Please provide a letter from your surety company. 4.3.3 Current bond Single and Aggregate limits and Bond Rate(as a percentage): 4.4 Insurance: 4.4.1 Name of insurance company: 4.4.2 Name, address, & phone # of agent: Page 5 of 6
5.SAFETY 5.1 OSHA Reported Accident/Incident History. 5.1.1 Provide OSHA 300 Summary Log for the last 3 full years, or the last full years your company has been in business. 5.2 Experience Modification Rate. 5.2.1 EMRs are obtained from your worker's compensation insurance carrier. Present year Last Year Two Years Ago EMR Effective Date(MM DD YYYY) 6.FINANCING 6.1 Financial Statement. 6.1.1 The following information is taken from Subcontractor s latest audited financial statement: (If an audited financial statement is not provided a bond may be required. Please complete Section 4.3 fully.) Current Assets (e.g., cash, joint venture accounts, accounts receivable, notes receivable, accrued income, deposits, materials inventory and prepaid expenses); Net Fixed Assets; Other Assets; Current Liabilities (e.g., accounts payable, notes payable, accrued expenses, provision for income taxes, advances, accrued salaries and accrued payroll taxes); Other Liabilities (e.g., capital, capital stock, authorized and outstanding shares par values, earned surplus and retained earnings). 6.1.2 Name, address, and phone number of firm preparing financial statement, and date thereof: 6.1.3 Is the referenced financial statement for the identical organization named on page one? 6.1.4 If not, explain the relationship and financial responsibility of the organization whose financial statement is provided (e.g., parent-subsidiary). 6.2 Will the organization whose financial information is provided act as guarantor of the contract for construction? Page 6 of 6