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Delphi Subcontractor Pre-Qualification

Home/Massachusetts Subcontractor Pre-Qualification
Massachusetts Subcontractor Pre-Qualificationed smi2017-11-22T19:03:53+00:00

Sub Contractor Qualification Form

Step 1 of 6 - General Information

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  • GENERAL INFORMATION

  • COMPANY INFORMATION

  • Date of Incorporation or Formation:State of Incorporation or Formation:Name of President, Managing Partner or Manager 
  • LICENSING, UNION STATUS AND EXPERIENCE

  • CraftLocationExpiration Date 
  • Project NameOwnerArchitectGeneral ContractorContract AmountCompletion Date% of Work Self-Performed 
  • Project NameOwnerArchitectGeneral ContractorContract Amount% CompleteScheduled Completion Date 
  • FINANCIAL INFORMATION

  • SURETY REFERENCES
  • Single ProjectAggregate
  • FINANCIAL REVIEW REQUIREMENTS – A confidential review of your company’s financial status must be conducted as part of this prequalification process. All information provided will be reviewed by Delphi’s CFO/President only, will be held in complete confidence and will not shared with anyone. Please contact Mark Paronich, CFO, at 781.893.9900 or via email at mparonich@delphiconstruction.com for specific submission requirements and to submit your information. DO NOT ATTACHED FINANCIAL INFORMATION TO THIS FORM.
  • Date FiledPlace FiledAmount of LawsuitDisposition of Claim 
  • INSURANCE AND SAFETY INFORMATION

    PLEASE PROVIDE THE FOLLOWING INFORMATION CONCERNING YOUR CURRENT INSURANCE COVERAGE. WHEN A SUBCONTRACT AGREEMENT IS ISSUED YOU WILL BE REQUIRED TO PROVIDE AN INSURANCE CERTIFICATE AS EVIDENCE OF COVERAGE CONFIRMING THIS INFORMATION.
  • Worker's Compensation

  • Commercial General Liability

  • Automobile Liability

  • Excess Umbrella Liability

  • Professional Liability

  • EMR RATING

    PROVIDE YOUR WORKERS COMPENSATION EXPERIENCE MODIFIERS FOR THE PAST TWO (2) YEARS. IF YOUR MODIFIER EQUALS OR EXCEEDS 1.00, YOU MAY BE REQUIRED TO PROVIDE ADDITIONAL INFORMATION SPECIFICALLY EXPLAINING THE FACTORS THAT CONTRIBUTED TO THE RATE PRIOR TO THE AWARDING OF ANY WORK.
  • Current YearRatingPrevious YearRating
  • OSHA SAFETY RATING

    PROVIDE THE TOTAL NUMBER OF OSHA SAFETY VIOLATION(S) FOR YOUR COMPANY OVER THE PAST 7 YEARS:
  • THIS INFORMATION CAN BE FOUND AT OSHA’S WEBSITE AT www.osha.gov/pls/imis/establishment.html
  • COMPLETE THIS SECTION IF YOUR ORGANIZATION PERFORMS ANY OF THE FOLLOWING WORK:

    • EXTERIOR INSULATING FINISH SYSTEMS (EIFS) • SLOPED GLAZING SYSTEMS • ROOFING SYSTEMS • WATERPROOFING AND DAMPPROOFING • PLASTER & LATH SYSTEMS • ALUMINUM ENTRANCES & STOREFRONTS • FLASHING AND EXTERIOR SHEET METAL J• OINT SEALANTS • GLAZED WALL SYSTEMS SKYLIGHTS • EXTERIOR PANEL SYSTEMS
  • DOES YOUR CURRENT POLICY EXCLUDE, IN ANY WAY, COVERAGE OR LIABILITY FOR:
  • Limit $Per
  • CERTIFICATION

  • Date Format: MM slash DD slash YYYY

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Waltham Office

Delphi Construction
Waltham Office
255 Bear Hill Road
Suite 301
Waltham, MA 02451
781 893-9900

Cape Cod Office

Delphi Construction
Cape Cod Office
17 Cape Drive
Mashpee, MA 02649
(508) 815-5555
Info@delphiconstruction.com

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