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Our
Mission
Who
We Are
Get
Involved
Subcontractors
Forms
Subcontractors Chicagoland Area
Union & Non-Union Pathways
Subcontractor Qualification Form
Prime Subcontractor QC Form
Workforce
Application
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1901 PRIME SUBCONTRACTOR QC FORM
PRIME SUBCONTRACTOR QUALIFICATION FORM
For firms willing to partner with a smaller MBE/DBE subcontractor
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Company Name:
Business Address:
City/State/Zip:
Phone:
Email
Website (if applicable):
Primary Contact Name & Title:
Year Established:
Legal Structure (Corp, LLC, Sole Prop, etc.):
State of Incorporation:
DUNS Number (if applicable):
Federal EIN:
Certifying Agency & Certification #: (if applicable)
Checkboxes
MBE
WBE
DBE
Section 3
Other
Primary Trade(s):
Other Trades Performed (if any):
Union Affiliation (if any):
Do you self-perform or subcontract your work?:
Average # of field employees:
Have you previously partnered with smaller MBE/DBE firms?
Yes
No
Are you open to mentoring a smaller subcontractor?
Yes
No
Describe your approach to capacity building and technical support for a smaller partner:
List up to three recent projects where you partnered with a small or minority subcontractor:
Project Name | Year | Contract Value | Minority Subcontractor Name | Scope of Partnership
Additional Experience and Notes:
EMR (Experience Modification Rate) for last 3 years:
OSHA Violations (past 3 years):
Yes
No
If yes, explain:
Current Safety Program in place?
Yes
No
Certified Payroll Capability:
Yes
No
Insurance Provider Name:
General Liability Coverage Limit:
Workers Comp Carrier:
Are you bondable?
Yes
No
Bonding Capacity – Single Project / Aggregate:
Surety Company & Contact Info:
General Contractor / Developer References (minimum 2):
Company Name | Contract | Phone | Email
DOCUMENT CHECKLIST (attach with submission)
Contractor’s License
MBE/WBE/DBE Certification (if applicable)
Safety Program
Insurance Certificate (ACORD)
W-9
Sample Certified Payroll Report
By signing below, I certify the information provided is accurate and complete. I understand this is not a contract or commitment but a request for qualification to partner on the 1901 Development Project.
*
By signing below, I certify the information provided is accurate and complete. I understand this is not a contract or commitment but a request for qualification to partner on the 1901 Development Project.
Signature:
Name (Print):
to Liability I
Title:
Date
Submit
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