Turner Prequalification Statement – Fill Out and Use This PDF

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Thank you for your interest in Turner Construction Company. In order to develop a more complete knowledge of your Company and better match future Company opportunities to your Company’s capabilities please complete this form and return to:

Turner Construction Company

3424 Peachtree Road, NE, Suite 1900

Atlanta, GA 30326

Attention: Purchasing Department

Phone: (404) 504-3700

Fax: (404) 504-3719

Date of Response:

SUBCONTRACTOR/VENDOR PREQUALIFICATION STATEMENT

Name of Company:

Street Address:

(city)

(state)

(zip)

Mailing Address:

(city)

(state)

(zip)

Phone:

Fax:

Contact :

Phone:

Cell Phone:

E-mail:

Contact

Phone:

Cell Phone:

E-mail:

Contact

Phone:

Cell Phone:

E-mail:

Website:
Is your Company:
MBE WBE	DBE	MBE/WBE/DBE Certified by:

Please attach copies of all certifications.

Is this address the:

Main Office

Regional Office

Branch Office

Name of Parent Company:

Address of Parent Company:

Trades

Please fill-in the trade(s) that your Company is interested in bidding

Year Company Started:		Type of Company:	Corp. Partnership Proprietorship Sub. S. Corp.
State of Incorporation:				Date of Incorporation:
Prequal.doc	1		5/12/04

SUBCONTRACTOR/VENDOR PREQUALIFICATION QUESTIONNAIRE (continued)
Contractor’s License Number:	State:	Expiration:		(Attach list if needed)
State Sales Tax Registration Number:			(attach list as needed)
State Unemployment Insurance Number:			(attach list as needed)

Federal ID Number

List the corporate officers, partners, proprietors, members and shareholders of more than 5% of the stock of your Company:

Name

Year of Birth

Position

Percent Owned

Under what other names has your Company operated?

How many people does your Company presently employ:

HomeOffice

Field Supervisory

Tradespeople

How many people did your Company employ on average for the last 3 years?

HomeOffice

Field Supervisory

Tradespeople

Has your Company or any of its principals ever petitioned for bankruptcy, failed in business, defaulted or been

terminated on a contract awarded to you?YesNo If 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?YesNo If yes, please explain:

Has your Company or any Owners, officers or major stockholders ever been suspended, disbarred or otherwise precluded from pursuing public work or ever been found to be non- responsive by a public agency?

	Yes	No
If yes, please explain:

Has your Company ever had a claim made against it for improper, delayed, defective or non-compliant work or failure to

meet warranty obligations?YesNo If yes, please explain:

Is your Company or any of its owners, officers or major shareholders currently involved in any arbitration or litigation?

	Yes	No
If yes, please explain:


Does you Company have any outstanding judgements or claims against it?	Yes	No
If yes, please explain:

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SUBCONTRACTOR/VENDOR PREQUALIFICATION QUESTIONNAIRE (continued

Please list any litigation brought against your Company in the past five (5) years asserting that you failed to make payments to anyone.

List the geographical areas in which you work :

List Unions which you have agreements with:

Local Number	Union Name	Agreement Expiration

Indicate the size of project you are most competitive in performing (enter 1). Show in preference order (2,3,…) other size projects you are capable of performing:

Under $100,000			$3,000,000 - $6,000,000
$100,000	- $200,000		$6,000,000 - $9,000,000
$200,000	- $500,000	$10,000,000 - $15,000,000
$500,000	- $1,000,000		Over $15,000,000

$1,000,000 - $3,000,000

Check all building types on which your Company has worked:

A.	High rise Office Building	F.	Sports/Entertainment
B.	Mid rise Office Building	G.	Industrial Bldg.
C.	Hotels/Motels	H.	High Tech/Laboratories
D.	Hospital	I.	Correctional Facilities
E.	Residential	J.	Design Build/Design Assist

List the trades you normally perform with your own forces:

What percentage of the Company’s work is normally subcontracted?

What trades do you normally subcontract?

What is the largest contract your Company has completed?

Amount:

Year:

Project name and scope:

What is the largest dollar volume job you expect to do during this year?

Amount:

Project name and scope:

What is your expected annual volume this year:

# of Projects

What was the average annual volume of work performed over the past 5 years:

Yr./Vol.		Yr./Vol.	Yr./Vol.
Yr./Vol.		Yr./Vol.
Prequal.doc	3		5/12/04

SUBCONTRACTOR/VENDOR PREQUALIFICATION QUESTIONNAIRE (continued
MBE/WBE Participation in work which you subcontract (average participation for last 3 years)	MBE	%	WBE	%
Minority/Female workforce participation (average percentage utilization for last 3 years)	MIN	%	FEM	%

Attach a list of current major projects giving name of project, address, owner, architect, general contractor, contract amount, scope of work and scheduled completion. (Include contact people and phone numbers)

Attach a list of completed major projects giving name of project, address, owner, architect, general contractor, contract amount and scope of work. (Include contact people and phone numbers)

Attach a copy of your latest audited financial statement. (Your financial statement is strictly for Turner Purchasing Dept use and will be treated confidentially).

If the attached financial statement is not for the identical Company named above, explain the relationship and financial responsibility of the Company whose financial statement is provided:

Name of your Bank:

Address:

Phone:

Contact Person:

Amount of line of credit:

Amount Available:

Expiration date:

UCC Filing?

Yes

How is credit secured:

What is Company’s Dunn & Bradstreet Number:

D&B Rating:

Pay Record:

Date of Rating:

Remarks:

Bonding Company:

Name of Surety

Key Contact Person/Phone

Bonding Capacity: Per Job

Aggregate:

Date of Last Bond

Amount:

Bond Rate

C.Please list the persons or entities who provide indemnification to your Surety:

List three of your major suppliers:

A.Name:

	Address:	Telephone:
	Contact:
B.	Name:
	Address:	Telephone:
	Contact:

C.Name:

	Address:	Telephone:
	Contact:
Prequal.doc	4	5/12/04

SUBCONTRACTOR/VENDOR PREQUALIFICATION QUESTIONNAIRE (continued)

List three contractors that you do business with:

A.Name:

	Address:	Telephone:
	Contact:
B.	Name:
	Address:	Telephone:
	Contact:
C.	Name:
	Address:	Telephone:
	Contact:

Trade Association Memberships:

List local or national accredited training programs in which you participate (craft or management training):

List key office personnel and field supervisors (attach resumes):

Name Position

Year of Birth

Years Experience

Previous Employer

List any subsidiaries and affiliates of your Company:

Company Name

Ownership

Type of Company

General Remarks:

We have attempted to answer all questions in a full and complete manner to assure that our answers are not in any respect misleading, either by expressing ourselves in a misleading or ambiguous manner or omitting information. We recognize that Turner will be relying on the accuracy of the information and our responses in this questionnaire in deciding whether to permit us to bid and in awarding work to our Company.

Dated at	this	day of Two Thousand and	(		)
Name of Company:
Completed by:				(must be an officer of the Company)
Title:

Title:

being duly sworn, deposes and says that the information provided herein is true and sufficiently complete so as to not be misleading.

Subscribed and sworn before me this		Day of		, 2

Notary Public:

My commission Expires:

Prequal.doc

5/12/04

Exhibit A

SUBCONTRACTOR Pre-Qualification Form

Safety Prequalification Form

1.Please list your Company’s Workers’ Compensation Interstate/Intrastate Experience Modification Rate for the most recent three years. (Attach a copy of your insurance carrier or state fund (on their letterhead) verifying the EMR data.

Interstate (Yr./Rate)

Intrastate (Yr./Rate/Name state(s) with abbreviations next to modification rate)

/	/	/	/	/	/
/	/	/	/	/	/
/	/	/	/	/	/
/	/	/	/	/	/

Note: Subcontractor’s must have a current EMR less than or equal to 1.0 to qualify for Turner Construction’s Bid List. Should your EMR exceed 1.0, the Contractor must demonstrate and document that it has or will initiate programs, policies, and attitudes which will result in a safety conscious performance in order to be included on Turner’s Approved Contractor List. In this case it is the sole discretion of Turner to approve or disapprove a SUBCONTRACTOR.

2.Please use the three most recent year’s OSHA No. 300/200 Log to fill in the number of cases for each of the following categories: (attach a copy of your last three years of OSHA 300/200 logs.)

Year

No. of fatalities (Column G from 300) or (Columns 1 + 8 from200)

No. of lost & restricted workday cases (Column H + I ) or (Columns 2 + 9)

No. of medical treatment cases (Column J ) or (Columns 6 + 13)

No. of lost workday cases (Column H ) or (Columns 3 + 10)

Employee Hours Worked

OSHA Recordable Incidence Rate

OSHA Lost Workday Incidence Rate

Note: --Items in parenthesis come from your OSHA 300/200 Log

--Recordable Incidence Rate = [G, H, I, & J] or [1,2,6,8,9,13] x 200,000 / Employee Hours Worked --Lost Workday Incidence Rate = [H] or [3 + 10] x 200,000 / Employee Hours Worked --Employee Hours Worked = total number of hours worked during the year by all employees

3.How many OSHA violation(s) has your Company received in the last three years?

(Yr. = # violations)

Any willful OSHA violations:

Yes

Please give a brief description of the violation(s); use additional paper if necessary

Any employee deaths in the past 3 years?

Yes

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5/12/04

If yes, please give a brief description of the circumstances:

Safety Prequalification Form (Continued)

5. Does this person do safety inspections on all of your projects:		Yes		No	Frequency

6.Do you have a written Company Safety Policy and Program and will you provide copies if

requested:

Yes

7. Does your Company have a substance abuse policy:

Yes

If Yes, please check which are included in the policy:

Pre-hire/Initial Employment

Cause

Post Accident/Incident

Random

Periodic

8. Do you have a return to work\light duty program?

Yes

If yes, please describe:

9. Have you ever implemented 100% fall protection	Yes	No
If requested can you provide us with a site-specific program addressing the fall hazards in
your work?			Yes	No

10.Do you require documented safety meetings for your employees? Indicate which, and how often.

Field Supervisors:	Yes	No	Frequency
New Hires:	Yes	No	Frequency
Employees:	Yes	No	Frequency
SUBCONTRACTOR/VEND	Yes	No	Frequency

	ORs:
11. Does your Company provide safety training for all employees:		Yes	No
	If yes, please list training provided.
	If yes, please list training provided.

(Turner will require that at least one full time on-site person must have completed the 30 hour OSHA training)

12.Do you have home office representatives (not directly involved in the project) who will visit and audit the project for safety:

Yes

Frequency

13. Does your Company set annual safety goals?

Yes

If yes, please list training provided.

Prequal.doc

5/12/04

14. Does your Company have a program recognizing your employees for safety performance excellence? Yes No

Safety Prequalification Form (Continued)

15.	Does your Company have a disciplinary program in place for safety violations?	Yes	No
16.	Does your Company review the safety management systems of your sub-subcontractors ?			Yes	No
17.	Does your Company conduct accident/incident investigations?	Yes	No

18.List all supervisory employees who have completed an OSHA 30 Hour Training Program.

Employee Name

OSHA 30 Hour

Date of

Certification

The undersigned warrants and represents the data provided is accurate in all respects.

Name of Company:

Prepared By:

Signature:

Title:

Date

Prequal.doc

5/12/04

Exhibit B

TURNER CONSTRUCTION COMPANY

Subcontractor Prequalification

Insurance Questionnaire

Agent/Broker:

Contact:

Phone:

A.Commercial General Liability Insurance Carrier:

1.	Policy Form	Policy Number	Policy Period	Occurrence Based
		From	to	Claims Made

2.Any exclusion from Standard CGL Policy? (Y/N)

3.	Limits:		Current			Max Obtainable
	General Aggregate		$			$
	Products-Comp/Op Agg.		$			$
	Personal/Adv. Injury		$			$
	Each Occurrence		$			$
	Fire Damage (any one fire)		$			$
	Med. Exp (any one person)		$		$
4.	Deductible: $

5.	Per Project limits	Yes		No

B. Excess Liability

Insurance Carrier:

1.	Policy Form	Policy Number	Policy Period	Occurrence Based
		From	To	Claims Made

2.Umbrella

Or Excess:

		Current	Max Obtainable
3.	Each Occurrence	$	$
4.	Aggregate:	$	$

C.Worker’s Compensation and Employer’s Liability Insurance Carrier:

1.	Policy Form	Policy Number		Policy Period
			From		To
2.	Limits		$
3.	E.L. Each Accident		$

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5/12/04

4.	E.L. Disease-Policy Limit	$
5.	E.L. Disease-Each Employee	$

D.Automobile Liability

Insurance Carrier:

1.	Policy Form	Policy Number		Policy Period
			From	To
			Current		Max Obtainable
2.	Combined Single Limit		$		$
3.	Bodily Injury (per person)		$		$
4.	Bodily Injury (per accident)		$		$
5.	Property Damage		$		$

E. Professional Liability Insurance Insurance Carrier:

1.	Policy Form	Policy Number		Policy Period
			From		To
2.	Office Policy Limit:		$		Deductible:	$
3.	Project Specific Limit available:		$		Extended Reporting Period (tail)			yrs.
					Prior Acts:		Yes		No

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5/12/04

Question	Answer
Form Name	Turner Prequalification Statement
Form Length	10 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	2 min 30 sec
Other names	turner subcontractor prequalification, turner construction subcontractor prequalification, thompson turner construction sc prequalification, turner sub constrator

4. Do you have a qualified person responsible for safety within your Company:

Please describe his/her qualifications: