Shakman Subcontractor Qualification Form

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Thank you for your interest in being placed on the Shakman Hospitality, LLC Subcontractor Bid List. Please fill out all the required fields on this form and click the Submit button. You will have an opportunity to review your entries before final submission. If required, you may save your progress and resume later by checking the box above.

If you have any questions or concerns please contact our Estimating Coordinator at 561-750-8288. Thank you.

GENERAL INFORMATION

Company Info

Company Name (Legal Name): *

Enter your legal company name

Company Name (DBA)

If different than legal company name

Physical Address:

Street Address *

Address continued

City *

State *

Zip *

Mailing Address (If not same as physical address):

Street Address

Address continued

City

State

Zip

Telephone #: *

Telephone number

Fax #:

Fax number

Toll Free #:

Toll free #

E-Mail Address:

E-Mail address

Trade(s): *

Enter the trade or trades performed by the company

Region(s) of Work: *

Enter the region or regions were the company performs work

Contacts

Main Contact

Main Contact: *

Name of main contact

Main Contact Title: *

Enter the title of the main contact

Available for Emergencies Yes

Is the main contact you entered available for emergencies?

Main Contact Phone #: *

Enter the phone number for the main contact person you entered

Main Contact Fax #:

If different from the company fax # entered above, enter the fax number for the main contact person you entered

Main Contact Mobile #:

Enter the mobile phone number for the main contact person you entered

Main Contact Home Phone #:

Enter the home phone number for the main contact person you entered

Main Contact E-Mail Address:

Enter the email address for the main contact

Alternate Contact

Alternate Contact:

Name of an alternate contact if available

Alternative Contact Title:

Enter the title of the alternative contact

Available for Emergencies Yes

Is the alternate contact you entered available for emergencies?

Aternate Contact Phone #:

Enter the phone number for the alternate contact person you entered

Alternate Contact Fax #:

If different from the company fax # entered above, enter the fax number for the alternate contact person you entered

Alternate Contact Mobile #:

Enter the mobile phone number for the alternate contact person you entered

Alternate Contact Home Phone #:

Enter the home phone number for the alternate contact person you entered

Alternate Contact E-Mail Address:

Enter the email address for the alternate contact

LEGAL/FINANCIAL

Years in Business: *

How many years the company has been in business

Type of Business: *

Such as: Partership, LLC, Corporation, etc.

Incorporated Place Name:

Location of Incorporation

Date of Incorporation:

When the company was incorporated

Number of Employees: *

How many people are employed by the company

Federal Tax ID #: *

Dun & Bradstreet #

Dun & Bradstreet Rating:

License Information

Ocupational License #: *

Enter your license number

County *

What county is the company licensed in

Expiration Date: *

Enter the occupational license expiration date

Florida Contractor License #

FL Contractor Lic. Expiration Date:

WORK HISTORY

Percentage of Work as GC:

What percentage of work done by company is done as a General Contractor

Percent of Work as Sub: *

Max Contract Value: *

What is the value of the companies larges contract to date?

Max Contract Period: *

Average Annual Work Value: *

Work Usually Sub'd Out?: * YesNo

Lost Work Days Last Yr:

Average Lost Days Last 5 Yrs.:

Medical Treatments Last Yr.:

Avg. Treatments Last 5 Yrs.:

Fatalities Last Yr.:

Avg. Fatalities Last 5 Yrs.:

Safety Program Contact:

Safety Program Phone #:

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