Industry PartnersIndustry PartnersPREQUALIFICATION FORMCompany Name*Mailing Address*Physical address*WebsiteCONTACTCompany President/Main contactName*Email*Phone*Estimating Contact (if different from above)NameEmailPhoneSafety Program Contact (if different from Main Contact)NameEmailPhoneScope of Work * Subcontractor SupplierTrades*Company Type* Corporation LLC Individual Partnership/joint venture OtherOtherDate of incorporationOther names your company operates under?Number of EmployeesOfficeManagement*Administrative/Office*Pre-Construction/Estimating*Total* FieldField Managers/Foremen*On Staff Tradespeople*1099 Workers*Total* Does your company subcontract any portion of your work? Yes NoIf yes, ExplainAre you an independent contractor under the Colorado Workers compensation Act? Yes NoWhere is your company willing and able to work? Vail Valley Roaring Fork Valley Summit County Telluride/Western Colorado OtherOther work locationsHave you completed projects in the areas selected above? Yes NoPlease list ReferencesProject Name*Contact*Contact Type*OwnerSubcontractorPartnerGCOtherEmail*Phone*AddRemoveFINANCIALVolume of work under contract at this time*$0 - $100,000$100,000 - $250,000$250,000 - $750,000$750,000 - $1.5M$1.5M - $5M$5M+Total Revenue Last Year*$0 - $100,000$100,000 - $250,000$250,000 - $750,000$750,000 - $1.5M$1.5M - $5M$5M+Total Profit before income tax*$0 - $100,000$100,000 - $250,000$250 - $750,000$750,000 - $1.5M$1.5M - $5M$5M+Total Revenue /Profit 2 years ago*Total Revenue/profit 3 years ago*Do you have a line of credit? Yes NoHow much credit do you have available?$0 - $100,000$100,000 - $250,000$250,000 - $750,000$750,000 - $1.5M$1.5M - $5M$5M+What is your total credit against?$0 - $100,000$100,000 - $250,000$250,000 - $750,000$750,000 - $1.5M$1.5M - $5M$5M+Please attach a current audited financial statement or balance sheet at the bottom of this formDrop a file here or click to uploadChoose FileMaximum file size: 10MBAre you bondable?* Yes NoIf yes, Please attach bonding agency letter.Drop a file here or click to uploadChoose FileMaximum file size: 104.86MBSAFETY/PERFORMANCEWHAT IS YOUR COMPANY'S EMR RATE?Current:Last year:Two years ago:List any/all judgements, pending claims, and lawsuits if any.Have you ever defaulted or failed to complete a project? Yes NoIf yes, ExplainInsurance Requirements:Insurance Requirements: All trade partners are required to meet and provide proof of RA Nelson insurance requirements. Please check each box acknowledging the insurance coverages required to work with RA Nelson. A communication will follow to coordinate with your insurance to confirm you have the required insurance coverages. If you do not currently meet the flowing requirements, our team is happy to work with you to increase your coverage where needed.General Liability Insurance – Occurrence: General Aggregate - $2,000,000 Products – Completed Operations Aggregate - $2,000,000 Personal & Advertising Injury - $1,000,000 Each Occurrence - $1,000,000 Fire Damage Legal Liability - $50,000 Medical Expense - $5,000Worker’s Compensation Insurance: Worker’s Compensation CoverageEmployer’s Liability Coverage: Limit of Liability, Each Accident - $1,000,000 Disease – Policy Limit - $1,000,000 Disease – Each Employee - $1,000,000Automobile Liability Insurance: Bodily Injury - $1,000,000 Each Accident Damage Combined including Owned, Hired and Non-Owned Autos – Combined Single LimitUmbrella Liability Insurance: Each Occurrence - $1,000,000 Aggregate, and must be following form - $1,000,000How did you hear about RA Nelson? Do you know anyone at RA Nelson?If you are human, leave this field blank.SubmitΔ
