Subcontractor and Material Suppliers Prequalification Form

Subcontractor & Material Suppliers Prequalification Form

Joseph J. Duffy Co. is eager to find new and qualified subcontractors and material suppliers.

Thank you for filling out our Subcontractor Prequalification Form

You have submitted all necessary information. Please give us 24-48 hours and one of our team members will contact you.

Company Name & Address

First Name *

Last Name *

Company Name

Business Address *

City *

State *

Zipcode/Postcode *

Country *

Contact Information

Work Phone Number *

Cell Phone Number

Home Phone Number

Fax Number

Email Address *

Website

General Business Information

How many years has your firm been in business?

Please select up to 2 categories

Job Field 1

Job Field 2

Is your firm: MBE / WBE / DBE Subcontractor Supplier

What percentage of your firm's business is industrial/commercial or multifamily housing?

Industrial/Commercial

Multi-Family Housing

Is your firm: Union Open Shop Prevailing Wage

Typical size of project

Is your firm bondable? Yes No

If yes, please answer the following questions.

Name of bonding company:

Value of largest project bonded:

Date

What is your bonding capacity?

Does your firm have the capability to receive download drawings and specifications from a Drop Box (or similar) site/link? Yes No

Please attach a separate sheet with three business references of jobs and major projects.

Attach File (100Mb Limit)

What are the minimum insurance limits that you carry?

General Liability

Automobile Liability

Workers Compensation

Excess Liability (Umbrella)

Do you provide a waiver of subrogation on Workers Comp?

Do you provide Completed Operations Insurance coverage coverage per GG2010 11/85 or similar form?

Do you have blanket additional insured’s endorsement?

Do you have an OSHA Certification Program for your on-site field staff? 10 Hour 30 Hour None

List your Worker Compensation Experience Modification Rate (EMR) for the last three years.

2012

2011

2010

2009

List any other information that pertains to your experience and qualifications that might be useful.

Servicing Chicagoland and the Midwest since 1923

Chicago
Vernon Hills
Waukegan
Oak Brook
Wheeling
Lawndale
Country Club Hills
Bartlett

Cook County
Dekalb County
Grundy County
Kane County
Kendall County
Lake County
McHenry County
Will County

(773) 777-6700