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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: *
Street Address:
City:
State:
v
Zip Code:
Contact Name:
Email: *
Federal Tax ID: *
Type of Company: *
Date Formed: *
v
Number 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?: *
If yes, list addresses:

Trade(s) Performed

(Subcontractors only)
Trade(s) of work:
Labor Union Affiliation:



Bonding Capacity

(Subcontractors only)
Can you bond projects?:
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:
v
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?
Bank 1:
Amount of Credit:

Outstanding Balance:
Lender's Name:
Lender's Address:
Lending Officer's Name:
Lending Officer's Phone Number:
Bank 2 (optional):
Amount of Credit:

Outstanding Balance:
Lender's Name:
Lender's Address:
Lending Officer's Name:
Lending Officer's Phone Number:
Bank 3 (optional):
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:
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:
Contracting Company:
Contact Name:
Contact Phone:

Reference 2

Company Name:
Contracting Company:
Contact Name:
Contact Phone:

Reference 3

Company Name:
Contracting Company:
Contact Name:
Contact Phone:


Client References

(List 3 clients)

Reference 1

Company Name:
Contracting Company:
Contact Name:
Contact Phone:

Reference 2

Company Name:
Contracting Company:
Contact Name:
Contact Phone:

Reference 3

Company Name:
Contracting Company:
Contact Name:
Contact Phone:

Company's Environmental Commitment

Does the company...
Have an environmental mission statement and/or policy?
Have a waste reduction and recycling program?
Educate employees and vendors about this program?
Participate in the salvage and/or reuse of waste materials?
Utilize recycled content construction materials?
Give details for any "yes" answer:


Other Information

In the past 5 years, has the company...
Operated under any other name?
Had any liens filed against it by any of its subcontractors or suppliers?
Ever failed to complete a contract, been defaulted, or had a contract terminated?
Had liquidated damages assessed against it upon completion of a project?
Had any of its key people been a party to a bankruptcy or reorganization proceeding?
Had any of its key people been involved in any lawsuit arising from a project?
Had any of its key people been investigated for or found to have committed a violation of any labor laws?
Had any of its key people been investigated for or found to have committed a serious OSHA violation?
Had or any of its key people been investigated for or found to have committed a violation of state/federal/local laws?
Give details for any "yes" answer:



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Bruner Corporation

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

info@brunercorp.com

Click here for a map to our facility.
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