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Specialty Contractor
Qualification Form

LGS Group, LLC

 

The list qualification process requires you to complete and return the enclosed form. See below for further instructions.

Qualification Process

1. Subcontractor Short Form Pre-qualification Questionnaire – the following items are required to complete this form.

  • a. General Information
  • b. Current Back Log
  • c. Annual Revenue – over the past three (3) years
  • d. Three (3) largest projects completed
  • e. References
  • f. Proof of insurance coverage as outlined in Attachment “I” (attached for your review) will be required before contract award can be finalized.

2. Financial Statement

3. LGS Disclaimer Statement

This information can also be faxed by downloading the PDF Versions and faxing completely filled out forms to the Business Development Department at (401)334-0692. Download PDF Version.

We thank you for your interest in our Branded Concept.

Specialty Contractor Short Form Pre-Qualification Package.
All Section must be Filled Out:
GENERAL INFORMATION:
Company Name:
Trade:
Street Address:
City:
State:
Zip Code:
Contact Name:
E-mail Address:
Telephone:
Fax:
Federal Taxpayer ID No:
Number of Employees:
How many years has your firm been in business?
Are you an open-merit shop company?
Revenue for the Year 2005:
Revenue for the Year 2006:
Revenue for the Year 2007:
Current Backlog:
Current Projects under Construction:
Project/Location Contract Percent Cost to Completion
Amount Completed Complete Date (yes/no)
Three major project Completed within the Last Two Years:
Project/Location Contract during the last Year /Owner/General Contractor
Amount Completed (yes/no)

REFERENCES:
Company Contact Phone Number Affiliation
INSURANCE REQUIREMENTS:
Have you read Attachment “Service Agreement” Insurance Requirements? Yes No
  • $1,000,000 General Liability
  • Company Owned Vehicles
Can your company presently meet these requirements? Yes No
Please list all exclusions to your insurance (I.e. E.I.F.S., Residential, etc.)
(If needed, please provide an additional sheet continuing your insurance exclusions)
SAFETY AND HEALTH INFORMATION:
Do you have a Safety Program? Yes No
Has your company received an OSHA citation within the past three (3) years? Yes No
Citations:
Current WC Experience Mod Rate:
CERTIFICATION:
I understand that the information provided will be used to qualify us for bidding only and more information will be required before any contracts are awarded. I understand the questions above and have answered them truthfully and to the best of my knowledge.
Name:
Title:
Company:
E-mail Address:
Date:
Service Agreement
INSURANCE REQUIREMENTS

All subcontractors shall purchase and maintain insurance of the types and in the amounts described below. The insurance shall be written by insurance companies acceptable to Contractor and on policy forms acceptable to Contractor. The insurance companies must be lawfully authorized to do business in the jurisdiction in which the job is located.

Workers Compensation & Employers Liability

Statutory Workers Compensation coverage for the state in which the job is located and the state of hire, if different; as well as any other state or jurisdiction as may be required.

Employers Liability Coverage with minimum limits of not less than:

  • Bodily Injury by Accident $500,000 Each Accident
  • Bodily Injury by Disease $500,000 Policy Limit
  • Bodily Injury by Disease $500,000 Each Employee

If applicable to the job, coverage under the Longshore and Harbor Workers' Compensation Act; the Jones Act or other Admiralty or Maritime Law; or any other Federal Workers Compensation and Employers Liability Laws, shall be provided.

Commercial General Liability

Commercial General Liability Coverage with minimum limits of not less than:

  • Bodily Injury and Property Damage Liability - Per Occurrence $1,000,000
  • Personal and Advertising Injury Limit - Per Person/Organization $1,000,000
  • Products - Completed Operations Aggregate Limit $2,000,000
  • General Aggregate Limit * $2,000,000

    * General Aggregate shall apply separately to this project.

Commercial General Liability Coverage must be written on an "occurrence" form and include the following coverage's: Premises-Operations, Independent Contractors, Contractual Liability, Products - Completed Operations, Personal and Advertising Injury. There shall be no limiting endorsements as respects: the scope of Contractual Liability coverage; "X, C, U" coverage; Broad Form Property Damage coverage Including Completed Operations. There shall be no "cross suits" exclusion which prohibits or eliminates coverage for suits or claims made against the Subcontractor by any party named as an Additional Insured. Contractual liability coverage shall apply to claims arising out of ongoing operations as well as Products-Completed Operations and shall not be limited as respects time period.
*, Inc. and other parties named as Additional Insured(s) above.


 

 
 

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