Subcontractor Qualification Interested in Working with Crosslands as a Sub Contractor? Start here by filling out this form and we’ll get in touch with you and see if we might be able to work together Name of Business* Address* Street Address Address Line 2 City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific ZIP Code Office Phone* Website Specialties* use the "+" symbol to add as many specialties as you like (Maximum 10) Experience Please tell us about your company and your experience. 0 of 500 max characters Employees* Start with the current year, then use the "+" symbol to add the previous two years. Year # of Field Employees # of Office Employees # of Total Employees Labor Unions - Signatory* Use the "+" symbol to add additional Labor Unions Contact for Bidding* Phone* Contact for Billing* Phone* Dunn & Bradstreet # Organization Type* (Corporation, S-Corporation, etc) Date Founded* mm/yyyy Years in Business Enter number of years Where Incorporated? State where incorporated Please Choose Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific Owners, Officers and Principals* Use the "+" symbol to add additional people Name Title Percent Ownership Licenses* Use the "+" symbol to add additional licenses Type of License State Number Legal Information Has your firm, its officers or principals been involved in any tax liens, bankruptcy or reorganization proceedings, failed to complete any work awarded to them, defaulted, or had a contract terminated for cause within the last five years?* Yes No If Yes, Please Explain 0 of 500 max characters Are there any judgements, tax liens, claims, lawsuits, arbitration or mediation proceedings currently pending or outstanding against your firm, its officers or principals?* Yes No If Yes, Please Explain 0 of 500 max characters Has your firm, its officers or principals filed any claims, lawsuits, arbitration or meidation proceedings with regards to a construction contract within the last five years?* Yes No If Yes, Please Explain 0 of 500 max characters Financials / Revenue Revenue Projected for This Year* Actual Revenue for Last Year* Actual Revenue for Two Years Ago* Contracts and Previous Work Largest Individual Contract Completed - This Year* Job Title Largest Individual Contract Completed - Last Year* Job Title Largest Individual Contract Completed - Two Years Ago* Job Title Completed Major Contracts - Last Three Years* Start with this year, then use the "+" symbol to add last year and then two years ago. Year Project Name Contractor Are key supervisory personnel on these projects still with your firm?* Yes No If No, Please Explain Bidding Interest What work do you normally perform with your own forces? 0 of 50 max characters What work do you normally subcontract to others? 0 of 50 max characters What geographical regions are you interested in bidding?* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific Key Project Personnel* Use the "+" symbol to add more personnel Name Role Phone Email Safety Workers' Compensation Experience Modification Rate (EMR) for the last five (5) years.* Year EMR Who is responsible for safety at your firm?* Use the "+" symbol to add additional safety personnel if necessary. Name Title Qualifications Years of Experience Do you have a written safety program?* Yes No What does senior management do to actively promote your safety program?* 0 of 250 max characters Any OSHA (Federal or State) Serious, Willful and or Repeat violations within the last five years?* Yes No If Yes, Please Explain 0 of 500 max characters Any EPA (Federal or State) violations within the last five years?* Yes No If Yes, Please Explain 0 of 500 max characters Banking, Surety and Insurance Bank Name* Branch Phone* Since (mm/yyyy)* Bonding Company* Bond Limits* Name of Agent* Address of Bonding Agent Street Address Address Line 2 City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific ZIP Code Phone of Bonding Agent* Since (mm/yyyy)* Insurance Company* General Liability, Automotive, Workers Comp and Umbrella Co.: Contact at Insurance Company* Phone Number for Insurance Company Contact* Email for Insurance Company Contact* Since (mm/yyyy)* References Supplier Reference* Use the "+" symbol to add more references Name Location (city, state) Contact Name Phone Number Contractor References* Use the "+" symbol to add more references Name Location (city, state) Contact Name Phone Number Consent* By typing your name below, the undersigned warrants and represents that the information provided herein is complete and accurate in all respects and explicitly authorizes the references identified herein to provide any additional information requested by the Contractor that it may require to complete its prequalification and evaluation process upon granting of a subcontract to Crosslands Construction Company. I agree Company Name* Officer's Name* Title* Date* MM DD YYYY CAPTCHA 5750 DTC Parkway #145 Greenwood Village, CO 80111 Need More Info? CONTACT US Subcontractor? Want to Work WIth Us? GET QUALIFIED Quick Links About Us Experience Gallery of Work Contact