Subcontractors

1. Company/Contact Information

Project for Submission*

Company Name*

Street Address*

City*

State* Zip Code*

Telephone Number*

Fax Number

Web Address

Contact Name*

Email Address*

Please select the option that best describes your business type*

2. Years In Business

Please select the geographic areas where you do business*

3. Company Officers

Primary

Name*
Title*
Email*

Secondary

Name
Title
Email

4. Insurance Information

Agent* Agent Contact* Agent Telephone Number* General Liability Carrier*
Commerical General Liability Limits* Umbrella*
Builders Risk* Auto Insurance Limits*

5. Workers Compensation Experience Modification Rate (EMR)*

NOTE: EMR required to work with Charter Builders Existing EMR Is*

6. Bonding/Surety Company Information

Agent* Agent Contact* Agent Telephone Number* Surety Company Rating* Aggregate Bonding Limit*
Single Bond Limit* Present Amount Bonded*

7. Business Classification and Type

Corporate In The State Of

MBE/WBE/HUB/Disadvantaged Certifications

Are You Currently Certified?*
Certifying Agency Certifying Agency Certifying Agency
Expiration Expiration Expiration

8. Division Of Work Performed/Materials Supplied/CSI Code*

Work/Material Item/Division* CSI Code* Work/Material Item/Division   CSI Code   Work/Material Item/Division   CSI Code   Work/Material Item/Division   CSI Code   Work/Material Item/Division   CSI Code  

9. Business/Project Size

Typical Size of Contract/Subcontract/Purhcase Order Award*
Last Year's Gross Annual Sales*
Last Three Years' Gross Annual Sales*
Current Backlog*

10. Three Most Recent Projects

Project #1

Project Name* Approx Contract Value* GC Contact* Owner Contact* Architect Contact*
Project Location (City,State)* General Contractor* GC Phone #* Owner Phone #* Architect Phone #*

Project #2

Project Name* Approx Contract Value* GC Contact* Owner Contact* Architect Contact*
Project Location (City,State)* General Contractor* GC Phone #* Owner Phone #* Architect Phone #*

Project #3

Project Name* Approx Contract Value* GC Contact* Owner Contact* Architect Contact*
Project Location (City,State)* General Contractor* GC Phone #* Owner Phone #* Architect Phone #*

11. Client/General Contractor Reference(s) - Name and Telephone

Client/General Contractor Reference #1

Name* Title* Email* Phone #*

Client/General Contractor Reference #2

Name   Title   Email   Phone #  

Client/General Contractor Reference #3

Name   Title   Email   Phone #  

12. Trade And Account Reference(s) - Name and Telephone

Trade/Account Reference #1

Name* Title* Email* Phone #*

Trade/Account Reference #2

Name   Title   Email   Phone #  

Trade/Account Reference #3

Name   Title   Email   Phone #  

13. Company Resume*

Please upload a copy of your company's resume (MS Word or Acrobat PDF Format)

I certify that the information provided is correct to the best of my knowledge and that I accept the above notice that completion of this form does not represent a contract offer or offer of work from Charter Builders LTD.

Reproduction in whole or in part in any form or medium without express written permission of Charter Builders, Ltd. is prohibited.
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