GENERAL INFORMATION

Company Name

Telephone

Fax

Email Address

Website Address



PAYMENT INFORMATION

Address

City

State

Zip

Country

Additional Address

Additional Information

Preferred Project Scope

Preferred Project Size: Please select 3. Under $50K$50K-100K$100K-200K$200K-500K$500K-1M$1M-3M$3M-6M$6M-10M$10M+



ATTACHMENTS

Please attach a copy of your company's certificate of insurance

Please attach a copy of your company's W9



LEGAL

Has your company or any if its principals ever petitioned for bankruptcy, failed in business, defaulted, or been terminated on a contract awarded? If yes, check here and enter explanatory notes.

Have any of the owners, officers, or major stockholders of your company ever been indicted or convicted of any felony or other criminal conduct? If yes, check here and enter explanatory notes.

Has your company or any of the owners, officers, or major stockholders ever been suspended, disbarred, or otherwise precluded from persuing public work or ever been found to be non-responsive to a public agency? If yes, check here and enter explanatory notes.

Has your company ever had a claim made against it for improper, delayed, defective, or non-compliant work or failure to meet warranty obligations? If yes, check here and enter explanatory notes.

Is your company or any of the owners, officers, or major stockholders involved in any arbitration or litigation? If yes, check here and enter explanatory notes.

Does your company have any outstanding judgments or claims against it? If yes, check here and enter explanatory notes.

Has your company or any of the owners, officers, or major stockholders ever been investigated for, or charged with, alleged labor law violations including alleged violations of Immigration Control and Reform Act; state or local laws regarding employment of immigrants; prevailing wage laws; wage and hour laws or other federal, local, or state labor laws? If yes, check here and enter explanatory notes.



CONTACTS

OWNER

Title

Years

Preferred Contact Method

Phone number

Fax number

Email address


ESTIMATOR

Title

Years

Preferred Contact Method

Phone number

Fax number

Email address


ACCOUNTING

Title

Years

Preferred Contact Method

Phone number

Fax number

Email address



SIGNATURE - all fields required

We have attempted to answer all questions in a full and complete manner to assure that our answers are not in any respect misleading, either by expressing ourselves in a misleading or ambiguous manner or omitting information. We recognize that Martin Horn, Inc. will be relying on the accuracy of the information and our responses in this questionnaire in deciding whether to permit us to bid and to award work to our Company.

Name of Company*

Completed by*

Title*

Date*