Taylor Bros. Construction Co. Inc.- A Harmon Group company

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Sub-Contractor Pre-qualification Form

Please fill out every field of this form marked with an *asterisk*.

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General
Name of Business	*
Street Address	*
Mailing Address (if different from above)
Telephone Number XXX-XXX-XXXX	*
Fax Number XXX-XXX-XXXX
Contact Person	*
Email	*
Website
Business Structure
Business Structure	*	Corporation Partnership LLC Sole Proprietorship General Contractor Sub-Contractor Supplier Work Self Performed
Years in Business under Present Organization	*
Name of President or CEO	*
Key Personnel (Name and Title) Enter one or more	*
Financial & Business Information
Sales volume for 2007 ( In dollars )	*
Sales volume for 2006 ( In dollars )	*
Sales volume for 2005 ( In dollars )	*
Bonding capacity in dollars	*
Bonding Company	*
Bonding Agent Name	*
Bonding Agent Phone Number XXX-XXX-XXXX	*
Bank Name	*
Bank Contact	*
Bank Phone XXX-XXX-XXXX	*
Amount of Bank Line of Credit	*
Affiliation	*	Union Non-Union
Total Number of Management Staff	*
Total Number of Superintendents	*
Total Number of Field Labor Employees	*
Are you certified as any of the following classifications If yes, please attach Certification(s)	*	Minority Business Enterprise (MBE) Women-Owned Business Enterprise (WBE) Disadvantaged Business Enterprise (DBE)
Legal
Are there any judgements, claims or suits pending, or outstanding against your company? If yes attach details	*
Are you now or have you ever been involved in any bankruptcies or reorganizations? If yes attach details	*
Have you ever failed to complete any work awarded to you? If yes attach details	*
EMR (Workers' Compensation Experience Modification Rate) for 2007	*
EMR (Workers' Compensation Experience Modification Rate) for 2006	*
EMR (Workers' Compensation Experience Modification Rate) for 2005	*
Insurance Company Name	*
Insurance Company Contact	*
Insurance Company Phone Number XXX-XXX-XXXX	*
Please Provide the Following
List your current projects At least one (1)	*
General Contractor References At least three (3) Phone numbers: XXX-XXX-XXXX	*
Owner References At least three (3) Phone numbers: XXX-XXX-XXXX	*
Supplier References At least three (3) Phone numbers: XXX-XXX-XXXX	*
The most recent year end Balance Sheet (Preferably Audited)	*
Confirmation
* By checking this box I certify the above information to be true and accurate to the best of my knowledge. By checking this box, the Contractor authorizes Taylor Bros. Construction Co., Inc. to contact all references and contacts listed on this form.