Dick Construction Subcontractor Application

Dick Construction Subcontractor Application
Company Information
Legal Company Name*
Other / Former Names
Parent Company, if Applicable
Company Organization*
Key Company Contact*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Physical Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address, if Different

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Licenses & Certifications
Contractor Registration Number
State Tax Number
Licenses
Date of Company Origination*

MonthDayYear
Certifications
List any categories of work your company normally performs not including subcontracted tasks.

Projects / Workflow
List any current and/or ongoing projects with approximate contract amounts and anticipated completion dates including any projects your company is about to undertake. *
Total worth of work in progress and under contract.*
List any major projects your company has completed in the past 5 years. *
State average annual amount of construction work performed during the past 5 years.*
List the construction experience and present commitments of the key individual of your company.*
Revenue

State your firm's projected total revenue for the current year and actual total revenue for each of the previous three years.
Projected Revenue for this Year*
Revenue (Last Year)*
Revenue (2 Years Prior)*
Revenue (3 Years Prior)*
References

Please list at least three (3) Trade References & at least one (1) Bank Reference. Be sure to include 1) Business Name, 2) Key Contact Personnel, 3) Address, 4) Phone Number & 5) an Email Address, if possible.
Trade Reference #1*
Trade Reference #2*
Trade Reference #3*
Bank Reference #1*
Bank Reference #2

Insurance Information
Do your current General, Excess and Auto Liability policies allow endorsement to name CHARTER and the Project Owner as additional insured parties stipulating that the insurance afforded protects the additional insureds and shall apply as Primary to any other insurance carried by any other contractors/subcontractors involved in subcontracted work?*
Does your policy provide “completed operations” coverage to additional insureds?*
Name of Your Company's Insurance Contact*
Job Title*
Phone Number*

Area CodePhone Number
Email*
example@example.com
Name of Insurance Carrier / Company*
Name of Insurance Agent / Broker*
Phone Number*

Area CodePhone Number
Address of Agency or Broker*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Bonding & Surety Information
Name of Surety
Bonding Agent Company
Name of Bonding Agent

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bond Premium Rate
Date of Last Bond Issued

MonthDayYear
Date
Payment & Performance Bond
Capacity Per Job
Capacity Aggregate
Documentation

IMPORTANT: To complete the pre-qualification process the following documents must be submitted:

1) SAMPLE INSURANCE CERTIFICATE & ENDORSEMENTS - Demonstrating your policy's language as it applies to named additional insureds (i.e. Primary/Non-Contributory, Waiver of Subrogation, etc.) and including Completed Operations, Employer Liability and Commercial Automobile Coverage.

2) FINANCIAL STATEMENTS - Please attach your last 2 years' audited, compiled or reviewed financial statements to the end of this form IF you anticipate bidding work packages whose values will be in excess of $100,000.

3) ADDITIONAL DOCUMENTS - Any additional information you believe may be relevant.
Sample Insurance Certificate & Endorsements*

Browse Files

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Financial Statements*

Browse Files

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Additional Documents*

Browse Files

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Additional Documents (2)*

Browse Files

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OSHA 300 Information
Year
Total Number of Recordable Claims
Total Number of Lost Time Injuries
Total Number of Employees
Total Number of Worker Hours
Has your organization ever failed to complete work within the stated contract completion date?*
Total Number of Fatalities
Safety / Policies
Does your company have a written safety program?*
Please Elaborate
Does your company have a return to work / light duty program?*
Please Elaborate
Does your company have a written substance abuse / testing program?*
Please Elaborate
Does your company review the safety management systems of your tier-subcontractors?*
Please Elaborate
Name of Safety Program Manager

First NameLast Name
Office Phone Number

Area CodePhone Number
Mobile Phone Number

Area CodePhone Number
Email
example@example.com

Claims / Lawsuits
Has your company ever failed to complete any work awarded to it?*
Please explain.*
Are there any judgments, claims, arbitration proceedings or lawsuits pending or outstanding against your company?*
Please explain.*
Has your organization filed any lawsuits or requested arbitration with regards to construction contracts within the last 10 years?*
Please explain.*
In the last 10 years, has any officer or principal of your company ever been an officer or principal of another company or organization that failed to complete a construction contract while they were in authority?*
Please explain.*

Authorization / Acceptance

I certify that the information contained in this application is correct to the best of my knowledge and is sufficient so as to not be misleading. I understand that to falsify information is grounds for refusing to hire our Company, or for discharge should we be contracted/subcontracted. Furthermore, completion of this application does not guarantee that our Company will be hired but is merely an offer of or request for consideration of the same.

I authorize any person, organization, business or company listed on this application to furnish Dick Construction, Inc. any and all information concerning any of the information contained, herein. Furthermore, I authorize Dick Construction, Inc. to request and receive such information.

I hereby authorize Dick Construction, Inc. and its designated agents and representatives to conduct a comprehensive review of our Company's background including an investigative consumer report to be generated for contracting/subcontracting purposes and understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of entity status; licenses and certifications; current and previous addresses; experience and history including personnel files; outstanding litigation; character references; criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; birth records; motor vehicle records to include traffic citations and registration; and any other public records or to conduct interviews with third parties relative to moral character and/or general reputation.

In consideration for subcontracting, our Company agrees to abide by the rules and regulations of the Dick Construction, Inc., whose rules may be changed, withdrawn, added or interpreted at any time, at the discretion of Dick Construction, Inc.'s sole option and without prior notice to our Company.

I also acknowledge that Company may be terminated, of any offer or acceptance of contracting/subcontracting withdrawn, at any time, with or without cause, and with or without prior notice at the option of Dick Construction, Inc. Should our Company choose to terminate any awarded work with Dick Construction, Inc., we agree to give a courtesy two (2) week notice.

By submitting this application I, the undersigned, do agree that I have authorization to complete such a request and agree to the foregoing on behalf of the Company.
Signature*
Printed Name*

First NameLast Name
Best Contact Number*

Area CodePhone Number
Best Time to Call*

Morning (8a-12p)Afternoon (1p-5p)Evening (5p-6p)
Email*
example@example.com
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