* = required field

GENERAL INFORMATION

ORGANIZATION STRUCTURE

PLEASE SELECT ALL TRADES YOUR FIRM SELF PERFORMS *

PERFOIRMANCE & CLAIMS HISTORY

Has your firm ever defaulted on, or been declared in default of, a contract? (If yes, please explain below)*   Yes No

Has your firm ever been terminated from a project? (If yes, please explain below) *   Yes No

Has your firm ever been involved in Bankruptcy or Re-Organization? (If yes, please explain in detail below) *   Yes No

Are there or have there been any claims or suits (including arbitration or administrative proceedings) by or against your firm in relation to your firms performance or compliance with applicable laws on a construction project, either pending or resolved, within the last five years? (If yes, please provide a description of all such claims or suits below, including case name, docket number, jurisdiction, description of the claims at issue, and the final outcome if applicable.) *   Yes No

Are there any pending or unpaid debts or judgments against your firm? (If yes, please provide a detailed explanation below) *   Yes No

Has your firm or any of its principals ever been debarred from bidding any state or federal public construction work? (If yes, please provide a detailed explanation below.) *   Yes No

Debarred State or Federal work? explanation

Has your firm or any of its principals ever been convicted of, or entered a plea of guilty, or no lo contendre, for criminal violations relating to, or arising out of, its business or the bidding or performance of a construction project? (If yes, please provide a detailed explanation below, including the case name, docket number, jurisdiction, and case description.) *   Yes No

Has your firm or its principals ever been found civilly liable for any criminal offense or civil action involving embezzlement; forgery; bribery; falsification or destruction of records; receipt of stolen property; collusion, antitrust, conspiracy or other similar offenses arising out of its business or the bidding or performance of a construction project? (If yes, please provide a detailed explanation below, including the case name, docket number, jurisdiction, and case description.) *   Yes No

SAFETY HEALTH & ENVIORMENTAL

Does your firm have a written safety policy? *   Yes No

Does your firm have a written drug policy?   Yes No

Does your firm have a full time site safety professional?   Yes No

In the past three years, has your firm been cited for any OSHA safety violations? (If yes, please provide an detailed explanation below, including the dates, violation types, description and inspection number of each violation.) *   Yes No

INSURANCE & BONDING

General Liability Limit * $

Worker Compensation *   Yes No

Is Firm Bondable?   Yes No

Bonding Single Project Limit $

Bonding Aggregate Limit $

PROJECT EXPERIENCE

Completed Projects Please list three (3) projects completed in the past five (5) years. Make sure to include the following Owner's / General Contractor's contact information Project address Type of project Total contract Completed Project - 1 Completed Project - 2 Completed project - 3

Currant Projects Please list three (3) projects currently under contract Make sure to include the following Owner's / General Contractor's contact information Project address Type of project Total contract Current Project - 1 Current Project - 2 Current Project - 3

Average annual Sales over the past 3 years $

Name *

Title *

Agree *
By agreeing the above named individual warrants and represents that the information provided is complete and accurate. By submitting this information, you are authorizing BBI to call upon the references identified to assist if needed in providing additional information that may be required to complete this evaluation process.

Agree

Date Entered *
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