Trinity Subcontractor Prequalification Form > Step 1 of 2: Submit

Trinity Subcontractor Prequalification Form

Please complete all requested information. Upon completion of the form please fax a copy of your insurance certificate to 978-657-5000 For questions please call Kevin Pombriant at 781-938-0008

Company Name: *

Address *

City *

State *

Zip Code *

Telephone Number *

Contact Name *

Estimating Contact *

Estimating Email Address

Company Type *

Federal Tax ID *

Number of Employees *

Years in Business *

Business Type:

N/A
WBE
MBE

Union Status

Union
Non-Union

Union Local

Trades your company performs *

Do you subcontract any work? *

Yes
No

If yes, what types?

Please list any trade licenses

Average Project Size for the past 12 Months *

In what Geographic Areas do you work? *

Have you ever worked with Trinity before?

Yes
No

Have you ever worked with a current Trinity employee?

Yes
No

If so, who and what projects?

List 3 current projects with name of GC, a contact name and phone number *

List 3 completed projects with name of GC, a contact name and phone number *

Has your company ever failed to complete a contract? *

Yes
No

If yes please explain:

Has your company ever been terminated by a GC? *

If yes please explain

Are there any pending lawsuits or claims against your company? *

Yes
No

If answer is yes please explain

Current Workers Comp Modifier *

Does your company have a written safety policy? *

Yes
No

Does your company have a drug use policy? *

Yes
No

Has your company been sited for any safety violations in the past 5 years? *

Yes
No

Explain any violations

Insurance Company Name *

Insurance Agent *

Agent Phone Number *

General Liability Limits-per occurence and aggregate *

Auto Liabiity Limits *

Workers Comp Limits-each accident/each employee/poicy limit *

Umbrella Insurance Limits, per occurance/aggregate *

Has any principal been convicted of a crime related to its business or any construction project? *

Yes
No

Please explain any convictions

Name of person completing this form *

Title of person completing this form *

Today's Date *

* indicates required fields

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