Company:

Contact Name:

Address:

City:

State:

Zip:

Phone:

Fax:

Cell:

Email:

Select One:    Corporation    Sole Proprietorship     Partnership  

Select One:    Minority Owned    Disabled Vet Owned     Woman Owned  

Select One:    Union    Non-Union 

Federal Tax ID #       

MN Tax ID #             

Contractor License # 

Is the Company name above identical with the Taxpayer ID number? Yes No 

Have you ever not paid your subcontractors/suppliers for completed work?YesNo

If yes, Please explain:

What percentage of work do you subcontract to others? 

Have you defaulted on or failed to complete a project?YesNo

If yes, Please explain:

Does your company have a company wide safety program: YesNo

Please list any OSHA citations against your firm for the past five years.

Are you able to receive .pdf plans by email: Yes No