Demolition Subcontractor Prequalification Form
Company Information
Company Name
Address
Phone
Email
Year Established
Federal Tax ID
Licensing & Insurance
License Number
License State
Expiration Date
General Liability Carrier
Policy Number
Coverage Amount
Workers' Compensation Carrier
Policy Number
Experience
Years in Demolition
Average Annual Volume ($)
Type of Demolition Work Performed
List Three Recent Projects
References
Reference Name
Company
Phone
Reference Name
Company
Phone
Safety
EMR (Experience Modification Rate)
OSHA Violations in Last 3 Years
Describe Your Safety Program
Signatures
Authorized Signature
Date
Title