Sussex Prequalification Form

Subcontractor / Vendor Prequalification

Thank you for your interest in doing business with Sussex Development Corporation. So that we may get to know your company better, please complete the following form.
- Company Name:
- Owner / President Name:
  
  First NameLast Name
- Owner / President Name Email:
  example@example.com
- Mailing Address:
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Physical Address (if different from above):
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Company Website:
- Main Office Telephone:
  Please enter a valid phone number.Format: (000) 000-0000.
- Estimating Contact Name:
  
  First NameLast Name
- Estimating Contact Cell Phone:
  Please enter a valid phone number.Format: (000) 000-0000.
- Estimating Email:
  example@example.com
- Estimating Email (to send ITBs):
  example@example.com
- Area(s) Served:
  Please include all locations (e.g., Hampton Roads, Richmond) that your company regularly services or performs work in.
- List Your Trade(s) as per CSI Division 0-33 (provide CSI # and Trade Name):
- If you are unsure of your company's CSI #, please visit https://constructionnotebook.com/wp-content/uploads/2016/06/MasterFormat_2016_NumbersTitles.pdf
- What is your organizational structure?
  (e.g., Individual/Sole Proprietor, S Corporation, C Corporation, Partnership)
- How many years has your company been in business?
- How many workers/crews do you have?
- What is a typical project value?
- List Self-Performed Work:
- List Contracted Work:
- EXPERIENCE - Please submit a summary of at least three typical projects reflecting the work your company typically performs, via the File Upload box below. Be sure to include the Project Name, General Contractor overseeing the project (provide a contact name and email address), project size, the dollar and description of the work performed.
- Is your company bondable?
  
  Other
- If "Other," add explanation:
- List your per project / per aggregate limits:
- Bonding Company Name:
- Bonding Company Contact:
  
  First NameLast Name
- Bonding Company Contact Email:
  example@example.com

- Indicate your company’s projected revenue for the current year:
- Indicate your company’s revenue for the prior year:
- Indicate your company’s current backlog of work:
- Indicate your company’s credit limit:
- Indicate the percentage of your credit limit currently in use:
- Sussex Development strives to protect all parties by requiring subcontractors maintain industry standard minimum insurance coverages. Please review our standard Subcontract Agreement Insurance Requirements.
- Is your company capable of meeting the listed limits:
- NOTE: Not having all our insurance requirements does not necessarily mean you can never work with Sussex. We will review exceptions on a case by case basis.
  
  Provide a Certificate of Insurance listing Sussex Development Corporation as additional insured with this application.
- Has your organization ever failed to complete work awarded to it?
- Are there any judgments, claims, arbitration proceedings or suits pending or outstanding against your organization or its officers?
- If the answer is “Yes” to any of the above questions, please provide the details below:

- Does your company require safety training for its employees?
- Does your company employ a safety coordinator?
- Indicate your company’s Experience Modification Rate for each of the last three years. Your insurance provider can help identify this information if you are unfamiliar with it.
- Year
- Rate
- Year
- Rate
- Year
- Rate
- Please be sure to upload a copy of the following documents to this application:
  
  1. At least three client references. Include name, company, telephone and email address.
  2. At least three project references (see “Experience”)
  3. Sample Certificate of Insurance listing Sussex Development as Additional Insured (see “Insurance”)
  4. A copy of your current State Contractor’s License (A, B or C)
  5. A copy of your W-9
  6. A copy of your current SWAM/MBE/HUB certificate, if applicable
- Additional Documentation:
  
  Cancelof
- Comments:
- The undersigned certifies the information provided herein is true and sufficiently complete as not to be misleading.
  
  Clear
- Respondent Name
  
  First NameLast Name
- Title:
- Date
  
  MonthDayYear
  Date
- Respondent Email
  example@example.com
- President Name if not signatory:
  
  First NameLast Name
- Please verify that you are human
- Should be Empty:

Subcontractor / Vendor Prequalification

Indicate your company’s Experience Modification Rate for each of the last three years. Your insurance provider can help identify this information if you are unfamiliar with it.