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* 1. Company Name:

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* 2. Company Street Address:

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* 3. Company City:

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* 4. Company State:

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* 5. Phone:

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* 6. Do you have 24 hour emergency service?

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* 7. Do you perform roofing, waterproofing and sheet metal work with your own forces?

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* 8. Is your company interested in:

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* 9. Principals/Titles:

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* 10. Project Management Contact:

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* 11. Service Management Contact:

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* 12. Number of Employees:

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* 13. Annual Sales Volume:

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* 14. Years in Business:

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* 15. NRCA member?

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* 16. Please provide all states which your organization is legally qualified to do business. Include license numbers and expiration dates, if applicable.

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* 17. List all business locations.

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* 18. Is your organization licensed to perform any other trades? 

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* 19. If you answered yes to Question 18, please identify below:

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* 20. Please select the markets your company has experience in:

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* 21. Please identify any certification your business holds:

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* 22. Please list all manufacturers your company is certified to install.

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* 23. Are there any judgments, claims, arbitration proceedings and/or suits pending against your organization or its officers in the last seven (7) years?

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* 24. Has your organization filed any lawsuits, arbitration, mediation, or liens with regard to construction contracts within the last seven (7) years?

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* 25. How many OSHA violations has your business incurred over the past three (3) years?

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* 26. What is your company’s Worker’s Comp EMR history for the last three (3) years and current year?

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* 27. Provide your bonding capacity, bonding company, and bonding company AM Best Rating.

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* 28. Please list three (3) trade references.

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* 29. Please provide contact information if we have other questions, or would like to speak with you further.

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