Pre-Qualification Questionnaire

Thank you for your interest in AnderCorp. In order to develop a more complete knowledge of your Company and better match future with AnderCorp opportunities to your Company’s capabilities, please complete the form below.

Apply Now

Vendor Prequalification Application

Step 1 of 5

20%

General Information

Name of Business

Business Address

Street Address Address Line 2 City State ZIP / Postal Code

Point of Contact

First Last

Phone Number

Name of Parent Company

Address of Parent Company

Street Address Address Line 2 City State ZIP / Postal Code

Date of Incorporation

Month

Day

Year

Type of Company

Corp

Partnership

S Corp

Proprietorship

LLC

Business Certifications

Is your company certified under any of the following classifications?

Small Disadvantaged Business (SBD)

HUB Zone Small Business (HUB Zone SB)

Native American

Women-Owned Small Business (WOSB)

Serviced-Disabled Veteran-Owned Small Business Concerns (SDVOSMC)

Historically Black College & Universities (HBCU) & Minority Institutions (MI)

Veteran-Owned Small Business Concerns (VOSMC)

Contractor's License Number

State

Expiration

Month

Day

Year

Previous Business Names

Has your company operated under any other names? If so, please list them below.

Work Classification

Please list the type(s) of work you are interested in bidding:

Please list the categories of work your firm normally performs with your own employees:

Please list the geographical areas in which you work:

Work Experience

Has your firm or any other organization, with which the officers or partners were involved during the past three (3) years, ever failed to complete any work awarded?

Yes

Please explain:

Are there any judgments, claims, arbitrations, proceedings or suits pending/outstanding against your firm or its officers or principals?

Yes

Please explain:

Has your firm filed any lawsuits or requested arbitration or mediation with regard to construction contracts within the last three (3) years?

Yes

Please explain:

Has your firm or any of its principals ever petitioned for bankruptcy, failed in business, defaulted or been terminated on a contract awarded to you?

Yes

Please explain:

Have any of the owners, officers or major stockholders of your Company ever been indicted or convicted of any felony or other criminal conduct?

Yes

Please explain:

Has your firm ever been disbarred or otherwise precluded from pursuing public work or ever been found to be non-responsive to a public agency?

Yes

Please explain:

Has your firm ever had a claim made against it for improper, delayed, defective or non-compliant work or failure to meet warranty obligations?

Yes

Please explain:

Average Job Size

Enter the average dollar ($) value of projects your company typically performs.

Largest Job to Date

Enter the dollar ($) value of the largest project your company has completed to date.

Financial Information

Attach a copy of your latest audited financial statement.

Financial information submitted through this form will be treated confidentially and used solely for AnderCorp’s internal review process.

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Bonding Information

Bonding Capacity Per Project

Bonding Capacity Aggregate

Bond Rate

Upload a copy of your “Good Guy Letter” from your surety company.

Note: Letter must come directly from the surety company.

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Insurance Information

Workers’ Compensation EMR Rates

Enter your company’s Workers’ Compensation Interstate/Intrastate Experience Modification Rate for the most recent three (3) years.

Year

EMR Rate

EMR Verification Letter

Attach a copy of your insurance carrier or state fund, on their letterhead, verifying the EMR rate

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Insurance Certificate

Upload your current insurance certificate, including general liability, workers’ compensation, auto, excess, and professional liability, if applicable.

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Safety

OSHA 300/200 Logs

Upload copies of your company’s OSHA 300/200 logs for the last three (3) years.

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Has your company recieved any OSHA violation(s) in the last three (3) years?

Yes

Please list the year(s) and number of violations.

Year

Number of Violations

Attach copy of OSHA violation(s), if neccessary

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Has your company recieved any willful OSHA violation(s)?

Yes

Please give a brief description of the violation(s):

Have there been any employee deaths in the past three (3) years?

Yes

Please give a brief description of the circumstances:

Do you have a qualified person responsible for safety within your Company?

Yes

Please provide his/her name and contact information:

First Last

Phone

Does this person do safety inspections on all of your projects?

Yes

How often are safety inspections conducted on your projects?

Do you have a written Company Safety Policy, and Program and will you provide copies if requested?

Yes

Is your company involved in any of the following types of work?

Electrical

Steel Contracting

Roofing

Heavy Excavation

No of the above

Please attach a copy of your Company Safety Policy and Program.

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Does your Company have a substance abuse policy?

Yes

Which of the following are included in your policy?

Pre-hire/Initial Employment

Random

Periodic

Cause

Post Accident/Incident

Do you have a return to work/light duty program?

Yes

Please describe:

Have you ever-implemented 100% fall protection?

Yes

If requested can you provide us with a site-specific program addressing the fall hazards in your work?

Yes

Does your company require documented safety meetings?

If yes, please indicate which of the following groups receive documented safety meetings and how often meetings are conducted.

Yes

Field Supervisors

Frequency

New Hires

Frequency

Employees

Frequency

Subcontractors/Vendors

Frequency

Does your Company provide safety training for all employees?

Yes

Please list training provided:

Does your Company have a disciplinary program in place for safety violations?

Yes

Does your Company review the safety management systems of your sub-subcontractors?

Yes

Does your Company conduct accident/incident investigations?

Yes