Qualification Statement

Required fields*:  
Basic Contractor Information
*Company Name:

*Street Address, City, State, Zip:

P.O. Box, City, State, Zip:

*Phone Number: 
Fax Number:
Other Number:
*E-mail Address:
Website URL:
 
Additional Contractor Information
*DUNS Number:
Maximum Job Size: $
State the approximate volume of construction work your company will perform in this calendar year.
$ As of (date):
State the approximate volume of construction work your company will perform that is currently under contract or pending notice to proceed in this calendar year.
$ As of (date):
 
*Business Status
According to the Small Business Administration (SBA), this company is a:
Small Business Enterprise Small Disadvantaged Business Enterprise
Woman Owned Veteran Owned
HUBZone, Cert # Certified 8(a) Business, Cert #
 
Contacts
*Contact #1: Name, Title, Alt Contact Number, Email    
 
   
*Contact #2: Name, Title, Alt Contact Number, Email    
 
 
Project References
List the two largest projects completed in the last two years.
Project Title #1 and Location:
Project Description:
   
Project Title #2 and Location:
Project Description:
   
*Bonding Information
Can your company secure bond? Yes No
Surety Name:
Surety Agent Name:
Surety Agent Phone Number:
Available Bonding Capacity :
Applicable bonding rate: $ per thousand

*A letter from your bonding company stating maximum bonding capacity is required to be returned with this form before any subcontracts can be considered for your company.

Please email a copy to info@vanguard1.com after completion of this form.

   
*Type of Work
Please check all that apply.
1000 General Conditions 9000 Finishes Fire Sprinklers
2000 Sitework 10000 Specialties Pavement Markings
3000 Concrete 11000 Equipment  
4000 Masonry 12000 Furnishings  
5000 Metals 13000 Special Construction  
6000 Wood & Plastics 14000 Conveying Systems  
7000 Thermal & Moisture 15000 Mechanical  
8000 Doors & Windows 16000 Electrical  
      Others (please list):
 
*Locations You Are Interested in Working
Andrews AFB, MD Fort Hood, TX Keesler AFB, MS Fort Campbell, KY
Fort Polk, LA Fort Stewart, GA Fort Hamilton, NY Langley AFB, VA
Little Rock, AR McConnell AFB, KS New Orleans, LA Scott AFB, IL
West Point, NY Whitman AFB Colorado Paducah, KY
Washington Statewide Nationwide  
 
Subcontractor Safety Evaluation
Do you conduct job site audits?: Yes No
Do you hold “Tool Box Talks” for employees?: Yes No
Tool Box documentation?: Yes No
How often?:
I have trained competent persons in the following areas:
Scaffolding Cranes
Excavation Electrical
List your firm’s EMR (Experience Modification Rate) for the last three years. (Year + EMR Rating)


 
List the following OSHA Log Information (past three years):
Year, Total Recordable Cases, Lost Workday Cases, Lost Workdays, Total Employee Hours Worked, Number of Fatalities
 
Have you been cited by OSHA in the past five years?
Yes No
 
List details of any citations your company has been involved in within the last five years.
 
List details of any litigations your company has been involved in within the last five years.

Vanguard Contractors
218 North 5th Street  •  Paducah, KY 42001
Phone: (270) 442-8620  •  Fax: (270) 442-0313
SITE DESIGN BY IVS