Prequalification Form

Please complete all applicable information in the form below to prequalify as a Bruner subcontractor or vendor. If you prefer to submit a printed version of the form, click here.

Subcontractor Identity
Company Name:
Address:
City:
State:   Zip: 
Contact Name:
Email Address:
Federal Tax ID:
Type of Company: Corporation
Partnership
Sole Proprietorship
Date Formed:
# of Employees:
Salaried:  
Hourly:
Average work in place during past 5 years:
Average work under contract during past 5 years:
Average project size during past year:
Average uncompleted backlog during past year:
Preferred size of projects:
Preferred location of projects:
Are there additional offices, plants, or warehouses at other locations? Yes
No

If yes, list addresses:
 
Trade(s) Performed (Subcontractors only)
Trade(s) of work:
Labor Union Affiliation:
 
Bonding Capacity (Subcontractors only)
Can you bond projects? Yes
No
Bonding rate: [%]
Single project limit:
Aggregate limit:
Bonding company:
Bonding company address:
Agent name:
Agent phone number:
 
Insurance Information (Subcontractors only)
Workers' compensation experience modifier:
Current experience modifier: [%]
Effective date:
You are required to verify your current workers' compensation modifier. If your experience modifier is .90 or higher, you may be asked to provide a copy of additional information for up to the past four (4) years.

General Liability Limits:
Per occurance: [$]:  
Aggregate: [$]
Insurance company:
Insurance company address:
Insurance agent name:
Insurance agent phone number:
 
Bank References
Does the company have a line of credit? Yes
No
Bank 1:
Amount of Credit:
Outstanding Balance:
Lender's Name:
Lender's Address:
Lending Officer's Name:
Lending Officer's Phone Number:
Bank 2: [+]
Amount of Credit:
Outstanding Balance:
Lender's Name:
Lender's Address:
Lending Officer's Name:
Lending Officer's Phone Number:
Bank 3: [+]
Amount of Credit:
Outstanding Balance:
Lender's Name:
Lender's Address:
Lending Officer's Name:
Lending Officer's Phone Number:
 
MBE/WBE/SBE/DBE/DVBE Certification
Check all certifications that apply to the company: MBE
WBE
SBE
DBE
DVBE
Certifying Agency(s):
 
Completed Projects (List 4 completed in past 5 years)
Project 1:
Project Name:
Contracting Company:
Contact Name:
Contact Phone:
Contract Amount:
Completion Date:
Project 2: [+]
Project Name:
Contracting Company:
Contact Name:
Contact Phone:
Contract Amount:
Completion Date:
Project 3: [+]
Project Name:
Contracting Company:
Contact Name:
Contact Phone:
Contract Amount:
Completion Date:
Project 4: [+]
Project Name:
Contracting Company:
Contact Name:
Contact Phone:
Contract Amount:
Completion Date:
 
Current Projects (List 4 current projects)
Project 1:
Project Name:
Contracting Company:
Contact Name:
Contact Phone:
Contract Amount:
Percent Complete:
Project 2: [+]
Project Name:
Contracting Company:
Contact Name:
Contact Phone:
Contract Amount:
Percent Complete:
Project 3: [+]
Project Name:
Contracting Company:
Contact Name:
Contact Phone:
Contract Amount:
Percent Complete:
Project 4: [+]
Project Name:
Contracting Company:
Contact Name:
Contact Phone:
Contract Amount:
Percent Complete:
 
Trade References (List 3 contractors or suppliers)
Reference 1:
Company Name:
Address:
Phone Number:
Contact Name:
Reference 2: [+]
Company Name:
Address:
Phone Number:
Contact Name:
Reference 3: [+]
Company Name:
Address:
Phone Number:
Contact Name:
 
Client References (List 3 clients)
Reference 1:
Company Name:
Address:
Phone Number:
Contact Name:
Reference 2: [+]
Company Name:
Address:
Phone Number:
Contact Name:
Reference 3: [+]
Company Name:
Address:
Phone Number:
Contact Name:
 
Company's Environmental Commitment
Does the company...
Have an environmental mission statement and/or policy? Yes
No
Have a waste reduction and recycling program? Yes
No
Educate employees and vendors about this program? Yes
No
Participate in the salvage and/or reuse of waste materials? Yes
No
Utilize recycled content construction materials? Yes
No
Give details for any "yes" answer:
 
Other Information
In the past 5 years, has the company...
Operated under any other name? Yes
No
Had any liens filed against it by any of its subcontractors or suppliers? Yes
No
Ever failed to complete a contract, been defaulted, or had a contract terminated? Yes
No
Had liquidated damages assessed against it upon completion of a project? Yes
No
Had any of its key people been a party to a bankruptcy or reorganization proceeding? Yes
No
Had any of its key people been involved in any lawsuit arising from a project? Yes
No
Had any of its key people been investigated for or found to have committed a violation of any labor laws? Yes
No
Had any of its key people been investigated for or found to have committed a serious OSHA violation? Yes
No
Had or any of its key people been investigated for or found to have committed a violation of state/federal/local laws? Yes
No
Give details for any "yes" answer:
 
Document Upload
  • Certificate of Insurance
  • Copy of last three years’ E.M.R. Ratings
  • Copy of current OSHA 300/300A Log
  • List of names and positions of dedicated safety staff
  • List of staff with OSHA Safety Certifications
  • Copy of BWC Certificate of Compliance for a Drug Free Workplace
Please zip up multiple documents before uploading.
   [Reset]



Location

Bruner Corporation
3637 Lacon Road
Hilliard, Ohio 43026
614-334-9000
614-334-9001 (FAX)

info@brunercorp.com

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