Vendor Information Form

A. COMPANY INFORMATION
Company Name:

Street Address:

City: State: Zip:

Office Phone #:	Office Fax #:
Company Website:	Company E-Mail:

Owner Names & Percentage of Ownership:

Estimating Contact with Cell #:

B. QUALIFICATIONS
Type(s) of work performed: (Plumbing, Roofing, etc.)

Type(s) of Projects: (Commercial, Residential, etc. with %)

Geographical area(s) served: (List Area Codes You Work in)

How many permanent people does your company emply?:
MGT OFFICE SHOP FIELD

Are You available to work night shifts if required? Yes No

How many temporary people does your company employ?

Annual Sales Volume:
2007 2008 2009

How many years has your company been in business?

What is your companys current backlog of uncompleted work?

Is your company a certified minority business? Yes No
Please upload a copy of your MBE Certificate.

Is your company licensed? Yes No
Lic. #: Type:

Value of work under contract: $

Can your company provide payment and performance bonds?
Yes No
If yes, What are the rates?
If yes, What is the bonding limit?

Name of Surety/Surety Agent and Phone Number:

Do you carry workmen's compensation insurance? Yes No
Dollar Amount: $

Do you have liability insurance in excess of $1,000,000? Yes No
Dollar Amount: $

Do you have a Drug Free Workplace Program? Yes No

Do you have a Safety Program? Yes No

Has Your Company ever failed to complete a Contract? Yes No
If Yes, please provide a detailed explanation.

Does Your Company construct Residential Housing or Condominiums?
Yes No
If Yes, please provide a list of all open projects:

Please identify the 5 largest projects your company has completed:
Project Name, Address, General Contractor Info, & Subcontract Amount
for the last 3 years.

Listing of at least 3 Suppliers and/or General Contractor References:
Company Name and Contact person with Phone Number.

Comments:

Other Forms of Contact

Phone: (941)377-6800

Fax: (941)378-2296

General Contact Form