CONTRACTOR PRE-QUALIFICATION FORM Company Overview Question Title * 1. Company Information First Name Last Name Title Email Phone Company Name Street Address City Zip Code Phone Website DUNS Number Federal EIN Question Title * 2. Year Established Question Title * 3. Type of Trade (s) performed? Question Title * 4. Number of Employees Administrative/Office Shop Field Question Title * 5. What type of labor is your firm capable of providing? Union Prevailing Wage Open Shop Question Title * 6. If union or prevailing wage, can you provide certified payroll reports to comply with local law? Yes No Question Title * 7. Certification Type Woman Owned Business (WBE) Minority Owned Business (MBE) Question Title * 8. Certifiying Agency The Port Authority of NY & NJ New York State Empire Development (ESD) NYC Department of Small Business Services (SBS) Other Certifying Agency Question Title * 9. Please list your insurance limits for the following policies General Liability (per occurrence, aggregate and umbrella) Workers Compensation Bonding Capacity Question Title * 10. What was your annual contract volume for the last 3 years? 2021 2020 2019 Question Title * 11. Are there any judgements, claims or pending suits or outstanding liens against you or your company? Yes No Question Title * 12. What is the largest size contract you are interested in performing? Question Title * 13. What is the largest size contract you have ever performed? Question Title * 14. What areas (locations) do you primarily operate within New York Metro Area (All Boros and New Jersey) Bronx Manhattan Queens Brooklyn Staten Island Question Title * 15. Attach Capability Statement PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Attach Capability Statement Question Title * 16. Provide three references: provide at least one for each trade Upload file with reference information including: client name, contact, phone number, type of work and dollar value PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Upload file with reference information including: client name, contact, phone number, type of work and dollar value Done
