Submitted To:
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Contact’s Name
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Submitted By:
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Contact’s Name
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Date:
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Date
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Holder Construction Company - Atlanta
3333 Riverwood Parkway, SE Suite 400
Atlanta, GA 30339
Telephone: 770-988-3000
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Company & Location Information:
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Firm:
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Company Legal Name
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Address:
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Office Address
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Holder Construction Company - Charlotte
2359 Perimeter Pointe Parkway, Suite 250
Charlotte, NC 28208
Telephone: 704-357-4200
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City:
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City
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State:
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State
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Zip:
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Zip
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Holder Construction Company - Dallas
4600 Fuller Drive, Suite 375
Irving, TX 75038
Telephone: 972-870-4260
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Phone:
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Phone
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Main Preconstruction Contact Person:
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Name:
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Name
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Holder Construction Company - Washington DC
2355 Dulles Corner Boulevard, Suite 501
Herndon, VA 20171
Telephone: 703-796-4400
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Title:
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Title
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Office Phone:
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Office Phone
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Extension:
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Office Phone Extension
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Holder Construction Company - Phoenix
2325 East Camelback Road, Suite 520
Phoenix, AZ 85016
Telephone: 602-224-5050
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Cell:
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Cell
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Email:
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Email
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Holder Construction Company - San Jose
2033 Gateway Place, 5th Floor
San Jose, CA 95110
Telephone: 408-516-4401
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References: Please list four different general contractors for whom you have performed similar scopes of work regarding similar facilities.
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1.
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Project
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2.
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Project
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(Project)
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(Project)
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General Contractor
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General Contractor
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(General Contractor)
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(General Contractor)
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GC’s Project Manager Name and Phone Number
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GC’s Project Manager Name & Phone Number
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(GC’s Project Manager Name & Phone Number)
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(GC’s Project Manager Name & Phone Number)
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Approximate Contract Value
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Approximate Contract Value
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(Approximate Contract Value)
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(Approximate Contract Value)
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3.
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Project
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4.
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Project
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(Project)
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(Project)
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General Contractor
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General Contractor
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(General Contractor)
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(General Contractor)
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GC’s Project Manager Name & Phone Number
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GC’s Project Manager Name & Phone Number
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(GC’s Project Manager Name & Phone Number)
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(GC’s Project Manager Name & Phone Number)
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Approximate Contract Value
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Approximate Contract Value
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(Approximate Contract Value)
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(Approximate Contract Value)
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Company Information:
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Self-Performed Scopes of Work:
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Scopes of Work
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Subcontracted Scopes of Work:
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Scopes of Work
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Type of Firm:
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Corporation
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☐
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Partnership
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☐
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Individual
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☐
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Other
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Other
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Parent Company:
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Same
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☐
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Name:
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Name
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Years in business as Contractor under present firm name:
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Years
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License Number:
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License Number.
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States in which your company will do business:
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List out all States.
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Is your organization union?
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Yes
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☐
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No
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☐
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If so list the affiliation(s) and local(s):
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Affiliation(s) and Local(s)
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Provide information which would indicate the size and capacity of your organization, including the number or permanent employees engaged in (do not count the same employee twice):
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Estimating:
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Number
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Field Supervision:
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Number
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Tradespeople:
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Number
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Clerical / Accounting:
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Number
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Management:
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Number
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Is your organization a registered DBE contractor?
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Yes
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☐
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No
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☐
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If so list certification type / number / body:
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Click here to enter text.
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Is your organization currently registered with Dun & Bradstreet?
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Yes
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☐
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No
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☐
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If yes, what is your D & B number?
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D & B Number
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What is your organization’s Experience Modification Rate (EMR)?
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Modification Rate
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If over 1.0, attach past three (3) years OSHA 300 logs.
Has your firm ever failed to complete a contract or been assessed schedule related damages?
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Yes
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☐
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No
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☐
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Has your firm had any subcontractors fail to complete a contract in the last five years
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Yes
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☐
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No
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☐
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Are there any judgments, claims, liens, or suits pending or outstanding against your firm?
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Yes
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☐
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No
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☐
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Has your firm been a party to any lawsuits, arbitration, or mediation with regard to construction projects in the last five years?
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Yes
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☐
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No
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☐
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*(If answer to any of the above questions is yes, please attach explanation to this form)
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Annual Billing:
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This year’s projected billing:
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$
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Billing
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Three Years Ago - Billing:
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$
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Billing
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Last Years - Billing:
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$
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Billing
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Four Years Ago - Billing:
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$
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Billing
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Two Years Ago - Billing:
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$
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Billing
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Five Years Ago - Billing:
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$
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Billing
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Five Largest Projects Completed in the Last Five Years:
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Project
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General Contractor, Contact and Phone Number
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Contract Amount
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Project
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General Contractor, Contact and Phone Number
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$
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Contract Amount
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Project
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General Contractor, Contact and Phone Number
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$
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Contract Amount
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Project
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General Contractor, Contact and Phone Number
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$
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Contract Amount
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Project
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General Contractor, Contact and Phone Number
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$
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Contract Amount
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Project
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General Contractor, Contact and Phone Number
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$
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Contract Amount
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Major Projects Under Contract:
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Project
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% of Contract Complete
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Completion Date
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Contractor
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Total Contract Value
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Project
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% Complete
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Date
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Contractor
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$
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Click here to enter text.
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Project
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% Complete
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Date
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Contractor
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$
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Click here to enter text.
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Project
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% Complete
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Date
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Contractor
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$
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Click here to enter text.
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Project
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% Complete
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Date
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Contractor
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$
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Click here to enter text.
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Project
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% Complete
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Date
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Contractor
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$
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Click here to enter text.
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Total value of projects under contract: (including those not listed above)
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$
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Click here to enter text.
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Percent of negotiated / bid contracts
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%
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% Negotiated / % Bid
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Current Pursuits: Current projects you are current a candidate for. (Indicate size and schedule)
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Project
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Start Date
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Contractor
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Total Contract Value
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Project
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Date
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Contractor
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$
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Click here to enter text.
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Project
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Date
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Contractor
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$
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Click here to enter text.
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Project
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Date
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Contractor
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$
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Click here to enter text.
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Project
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Date
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Contractor
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$
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Click here to enter text.
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Project
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Date
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Contractor
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$
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Click here to enter text.
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Bonding Information
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What is your bond rate for this project (as a percentage)
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%
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Rate
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Aggregate Limit:
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$
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Aggregate Limit
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Single Project Limit:
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$
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Single Project Limit
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Please list the names of your bonding agent and surety:
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Bonding Agent
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Surety
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(Bonding Agent)
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(Surety)
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Street Address
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Street Address
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(Street Address)
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(Street Address)
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City, State, Zip
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City, State, Zip
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(City, State, Zip)
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(City, State, Zip)
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The answers to the foregoing questions and all statements herein contained are true and correct.
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Reviewer’s Position
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|
Reviewer’s Position
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(Reviewer’s Name)
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(Reviewer’s Position)
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* Holder Construction reserves the right to request Audited Financials which is defined as a Balance Sheet, and Income Statement, an Auditor’s Report and Footnotes.
Holder Construction Version 04/16/2013 Page of
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