Subcontractor Application Step 1 of 4 - Company Information 25% Blanton Construction Surcontracter/ Supplier Qualifications List: If your company would like to become part of our bid list, please fill out the following & submit.Name First Last Company InformationCompany Name Contact Name Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneFaxEmail Are you a Supplier or Contractor Supplier Contractor Trade or Type of Work (list all applicable divisions and sections)How many years has your organization been in business under its present business name? Are you AFL-CIO affiliated? Yes No Company Experience & HIstoryList the categories of work that your organization normally performs with its own forces.Does your company possess Design/Build capabilities? Yes No Has your organization ever failed to complete any work awarded to it? Yes No ExplainAre there any judgments, claims, arbitration proceedings or suits pending or outstanding against your company? Yes No ExplainHas your company filed any lawsuits or requested arbitration with regard to construction contracts within the last five years? Yes No ExplainList projects your company has in progress or in the pipeline. Name of Project General Contractor Architect Owner Contract Amount Percent Complete Scheduled Completion Date MM slash DD slash YYYY UntitledWhat has been your annual volume over the past three years? List the quantity of key individuals of your organization. *Note: Not applicable if supplier only.Owners Officers Manager Engineers Superintendents Foreman Field Labor Administrative Other Safety HistoryExperience Modification Rating: Indicate your (EMR) for the current year and the two previous years.Current Year Previous Year 2nd Previous Year Have you been cited by Federal or State OSHA for serious violations? Yes No ExplainDo you have a written safety program? Yes No References & Financial InformationList at least three references (general contractor, owner, supplier or subcontractor). Reference TypeGeneral ContractorOwnerSupplierSubcontractorPhoneUntitledList bank referencesList name, address, phone, and contact of your bonding company/agentName First Last Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneContact What is your bonding capacity? Confirmation of InformationName First Last Title