supplier prequalification questionnaire · reference letter from bank officer stating line of...

Conway, AR | Little Rock, AR | Jonesboro, AR | Fort Smith, AR | Rogers, AR | Springfield, MO | Olathe, KS | Tulsa, OK | Oklahoma City, OK | Olive Branch, MS

nabholz.com | 1-877-NABHOLZ

Revised: 8/18/2013 1

Dear Supplier:

To better maintain your company information in our database, we are providing you with the attached Supplier Prequalification Questionnaire along with these instructions, to update your Company Setup information on an annual basis. Please complete the attached Supplier Prequalification Form in its entirety and return to one of the procurement coordinators listed on the signature page of the form. All information will be held in strict confidence within the Nabholz family of companies and will be utilized for in-house analysis of qualification. Along with completing the Supplier Prequalification form we request that you provide the following list of documents for review by our supply chain review team.

Additionally, any Supplier whose purchase order is anticipated to be greater than $1,000,000 shall also submit the following financial information:

Letter of good standing from surety providing years of relationship, verification of bond rate, and single project and aggregate surety limits. Letter must also include the Surety’s A.M. Best Rating

Accord 25 Certificate of Liability Insurance in compliance with the attached Sample.

Litigation Disclosure; explaining any suspensions, denials, revocations, petitions for bankruptcy, contract terminations, judgments, liens, claims, arbitration proceedings in which your firm has filed or been a party to.

OSHA 300/300A logs last three (3) years

Current Work In Progress Report

Reference letter from bank officer stating line of credit, basis extended, how much unsecured and secured, what security required, overall banking relationship, and years of relationship

Current year-end financial statement (audited or reviewed)

Thank you for your participation in this Company maintenance effort. Nabholz owes its long history of successful business to successful relationships with clients, subcontractors, and suppliers. And we look forward to building a successful relationship with your firm as well.

Sincerely,

Nabholz Construction Corporation



Revised: 8/18/2013 2

SUPPLIER PREQUALIFICATION QUESTIONNAIRE

I. GENERAL INFORMATION

Federal Tax ID:

Company Name:

Street Address: (City, ST Zip)

Mailing Address: (City, ST Zip)

Main Contact:

Title:

E-mail:

Telephone: Fax: Cell:

Estimating Contact: Title:

E-mail:

Telephone: Fax: Cell:

Trade Description(s):

II. CERTIFICATIONS

Classifications Bonding and Insurance

WBE – Women-owned MBE – Minority DBE – Disadvantaged VBE – Veteran SBE – Small Business State Classification Federal Classification Other Classification

Other Class Description: Classification Certified By:

Bondable Bonding Company: Phone: Bonding Capacity – Aggregate: Bond Limit per Project: Insurance Contact: Insurance Tel:

Explain any work that your firm or any affiliated firm has had completed or supported by a surety.

Check if none

What is your bond premium rate? If it is a tiered rate, please list tiers.

III. Divisions of Work

CSI – Description CSI – Description



Revised: 2/12/2014 3

01-5423 - Temporary Scaffolding and Platforms

01-5526 - Traffic Control

01-5626 - Temporary Fencing

03-1505 - Concrete Accessory Material

03-1520 - Expansion Joint Material

03-2100 - Reinforcement Bars

03-2205 - Wire Mesh

03-2400 - Fibrous Reinforcing

03-3005 - Ready Mix Concrete

03-3010 - Caissons

03-3913 - Concrete Curing

03-3920 - Concrete Hardener

03-4713 - Tilt-Up Concrete

04-0523 - Masonry Accessories

04-0525 - Wall Flashing

05-1205 - Structural Steel Framing (Supply)

05-1300 - Stainless Steel

05-4400 - Cold-Formed Metal Trusses

05-5000 - Metal Fabrications

05-7000 - Decorative Metal

05-7313 - Glazed Decorative Metal Railings

06-1753 - Shop-Fabricated Wood Trusses

06-1800 - Glued-Laminated Construction

06-6100 - Simulated Stone Fabrications

07-6000 - Flashing and Sheet Metal

07-7200 - Roof Accessories

07-7600 - Roof Pavers

07-9500 - Expansion Control

08-1113 - Hollow Metal Doors and Frames

08-1400 - Wood Doors

08-1500 - Plastic Doors

08-3113 - Access Doors and Frames

08-4500 - Translucent Wall and Roof Assemblies

08-5100 - Metal Windows

08-5200 - Wood Windows

08-6200 - Unit Skylights

08-6700 - Finish Hardware

08-9500 - Vents

10-1100 - Visual Display Units

10-1116 - Markerboards and Tackboards

10-1400 - Signage

10-1416 - Plaques

10-2113 - Toilet Compartments

10-2123 - Cubicle Curtains and Track

10-2219 - Demountable Partitions

10-2226 - Operable Partitions

10-2613 - Wall and Corner Guards

10-2623 - Impact Resistant Wall Protection

10-2800 - Toilet, Bath and Laundry Accessories

10-3200 - Fireplace Accessories

10-4116 - Emergency Key Cabinets

10-4400 - Fire Protection Specialties

10-5100 - Lockers

10-5723 - Closet and Utility Shelving

10-7500 - Flagpoles

10-8200 - Grilles and Screens

11-1400 - Pedestrian Control Equipment

11-2300 - Laundry and Dry Cleaning Equipment

11-3100 - Residential Appliances

11-4000 - Foodservice Equipment

11-5200 - Audio-Visual Equipment

11-5213 - Projection Screens

11-5300 - Laboratory Equipment

11-6100 - Theater and Stage Equipment

11-6600 - Athletic Equipment

11-6800 - Play Field Equipment and Structures

11-7000 - Healthcare Equipment

11-9100 - Religious Equipment

12-4000 - Furnishings and Accessories

12-4813 - Entrance Floor Mats and Frames

12-9300 - Site Furnishings

IV. Regions of Work

St Code – City St Code – City St Code – City



Revised: 2/12/2014 4

AL-Alabama

AR-Batesville

AR-Camden

AR-Fayetteville

AR-Fort Smith

AR-Harrison

AR-Hot Springs

AR-Jonesboro

AR-Little Rock

AR-Pine Bluff

AR-Russellville

AR-Texarkana

AR-West Memphis

AZ-Arizona

CA-California

CO-Colorado

CT-Connecticut

DC-Washington D.C.

DE-Delaware

FL-Florida

GA-Georgia

IA-Iowa

ID-Idaho

IL-Illinois

IN-Indiana

KS-Belleville

KS-Colby

KS-Dodge City

KS-Emporia

KS-Fort Scott

KS-Hays

KS-Hutchinson

KS-Independence

KS-Kansas City

KS-Liberal

KS-Salina

KS-Topeka

KS-Wichita

KY-Kentucky

MA-Massachusetts

MD-Maryland

ME-Maine

MI-Michigan

MN-Minnesota

MO-Bowling Green

MO-Cape Girardeau

MO-Chillicothe

MO-Columbia

MO-Flat River

MO-Hannibal

MO-Harrisonville

MO-Jefferson City

MO-Joplin

MO-Kansas City

MO-Kirksville

MO-Poplar Bluff

MO-Rolla

MO-Sedalia

MO-Sikeston

MO-Springfield

MO-St. Joseph

MO-St. Louis

MS-Mississippi

MT-Montana

NC-North Carolina

ND-North Dakota

NE-Nebraska

NH-New Hampshire

NJ-New Jersey

NM-New Mexico

NV-Nevada

NY-New York

OH-Ohio

OK-Ardmore

OK-Clinton

OK-Durant

OK-Enid

OK-Guymon

OK-Lawton

OK-McAlester

OK-Miami

OK-Muskogee

OK-Oklahoma City

OK-Ponca City

OK-Poteau

OK-Shawnee

OK-Tulsa

OK-Woodward

OR-Oregon

PA-Pennsylvania

RI-Rhode Island

SC-South Carolina

SD-South Dakota

TN-Tennessee

TX-Texas

UT-Utah

VA-Virginia

VT-Vermont

WA-Washington

WI-Wisconsin

WV-West Virginia

WY-Wyoming



Revised: 2/12/2014 5

V. LEGAL/FINANCIAL INFORMATION

Business Type: Years in Business No. of Employees

State of Formation Date Established Dun & Brad No. D & B Rating

Principals Fictitious [Trade or dba] Names

List Business Owners and Key Officers

Name, Title – Yrs. in Position

List any fictitious [trade or dba] names or affiliate companies under which your firm operates

Litigation Information:

Explain any [petitions for bankruptcy] that your firm or any affiliated firm or any of your owners, officers or principals has filed. Check if none

Explain any [failure to complete] or [termination for cause] that your firm or any other organization with which your owners, officers or principals were involved with during the past 5 years. Check if none

Explain any judgments, liens, claims, arbitration proceedings, or suits pending/ outstanding against your firm or its owners, officers or principals. Check if none

Explain any lawsuits or requested arbitration or mediation with regard to purchase orders that your firm has filed or been the subject of within the past three years. Check if none



Revised: 2/12/2014 6

Trade References: (minimum two (2) per group)

OWNERS:

Name of Company Contact Phone Number

GENERAL CONTRACTORS:


SUBCONTRACTORS:


SUPPLIERS:




Revised: 2/12/2014 7

By executing below, I am acknowledging that Nabholz Construction and the Owner will be relying upon the accuracy of this above information to assist them in determining in their discretion whether any organization can be selected bidder for individual work categories or combined work categories as established in the bid documents.

I understand the questions above and have answered truthfully and to the best of my knowledge.

Name: Title:

Signature: ____________________________________ Date:

Please return the completed Supplier Prequalification Questionnaire, along with attachments to one of the following Procurement Coordinators:

Nabholz Construction Services South-Central Operations Conway, AR Jonesboro, AR Little Rock, AR Olive Branch, MS Attn: Sarah McMillian 612 Garland Street Conway, AR 72032 (W): +1 (501) 505-5829 [email protected]

Nabholz Construction Services Midwest Operations Rogers, AR Fort Smith, AR Springfield, MO Attn: Gail Ward 3301 N 2nd StRogers, AR 72756(W): +1 (479) 659-7834 [email protected]

Nabholz Construction Services Southwest Operations Tulsa, OK Attn: Mykala Phillips 10319 East 54th Street Tulsa, OK 74146 (W): +1 (918) 632-7200 [email protected]

Nabholz Construction Services Midwest Operations Olathe, KS Attn: Michele Coleman 1707 E 123rd Terrace Olathe, KS 66061 (W): +1 (913) 393-6522 [email protected]

Nabholz Construction Services Construction Operations Oklahoma City, OK Attn: Courtney Baker 6400 South Superior Ave. Oklahoma City, OK 73149 (W): +1 (405) 979-4420 [email protected]

mailto:[email protected]





supplier prequalification questionnaire · reference letter from bank officer stating line of...

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