Asbestos Abatement Subcontractor Prequalification
Company Information
Company Name
Address
City
State/Province
Postal/Zip Code
Contact Name
Phone Number
Email
Date Established
Licensing & Certification
Asbestos License Number
Issuing State/Authority
Expiration Date
Company Certifications
Insurance Information
General Liability Insurance Carrier
Policy Number
Expiration Date
Workers' Compensation Carrier
Policy Number
Expiration Date
Project Experience
Project Name
Location
Year
Scope/Description
Safety Record
OSHA Recordable Incidents (last 3 years)
EMR (Experience Modification Rate)
Fatalities (last 5 years)
References
Name
Company
Phone
Email
Additional Information
Comments