C &N Industrial  Contractors, Inc.

Subcontractor Pre-Qualification Application

To be considered as a Subcontractor, please fill out and submit the following form

Contact Information:

Company Background:

• Type of organization: Incorporated LLC Sole Proprietorship Partnership Other (specify below)

• If other, please explain:

• Year of incorporation (or origination):

• Type of work (scope) you provide:

• Does your company provide: Labor Only Material Only Both Labor and Material

• Geographical work area:

• Have you ever failed to complete a project: Yes No

• If yes, please explain:

• Do you qualify for any of the following: MBE SBE WBE EDGE DBE N/A

• Do you have an ongoing safety plan in place: Yes No

• Total number of employees:

• Do you have a current workers compensation certificate: Yes No

• Do you participate in the BWC Drug Free Work Place Program: Yes No

• C&N Industrial Contractors, Inc. requires liability insurance from all Subcontractors on every project.  Insurance limitations must match or exceed contract requirements as set forth by each specific project owner.  Certificates must always list C&N Industrial Contractors, Inc. and respective project owner as additional insured for the duration of each project.  Note here that you understand and agree to these terms: Agree Do Not Agree

• C&N Industrial Contractors, Inc. requires all sub-contractors to have a State of Ohio Contractor’s Compliance Certificate.  Do you have a current Certificate provide copy with this application: Yes No

1. If Yes, please provide a copy with this application. 

2. If No, may be applied for at http://das.ohio.gov/eo

• C&N Industrial Contractors, Inc. e-mails invitations to bid to subcontractors.  Does your company have the ability to receive e-mail invitations: Yes No

• If applicable for your scope of work, do you provide design/build services: Yes No

• If required for your scope of work, do you outsource shop drawings or are they produced in-house: Outsource In-House N/A

Professional References

Contractors (list at least 3 local):  

1. Company Name:

Contact:

Phone Number:

2. Company Name:

Contact:

Phone Number:

3. Company Name:

Contact:

Phone Number:

Projects (at least 3):

1. Project Name:

Address:

Scope:

Date Completed:

2. Project Name:

Address:

Scope:

Date Completed:

3. Project Name:

Address:

Scope:

Date Completed:

• Additional comments for consideration: