Subcontractors / Vendors

Subcontractors Pre-Qualification Form

Please complete the form below to pre-qualify with LeLack Construction.

* - required fields

Business Section

Business Type *

Have you failed to complete awarded work or been terminated for cause? Do you have any judgments, claims, arbitrations, suits or liens currently against your organization? Had any bankruptcies or reorganizations? *
  * If yes, please explain below:

Safety Section

Enter your Experience Modification Rate(EMR) for the last three years:

Do you have a written safety program? *

Project Information Section

Enter data from three most recent completed fiscal years:


Max. Contract Value
Annual Company
Current Year Company

List license numbers in jurisdictions in which you company is legally qualified to work:

License Number

Insurance and Bonding Section

Do you currently carry, or can you obtain the following insurance coverage? *


Total Bonding
Capacity $
Current Available
Bonding Capacity $

Reference Section

Project References (Within Last Three Years)

Scope Of Work Section

(Scopes Of Work That Your Company Performs) *

Confidential Note:

The information supplied by the undersigned in this document is intended only for the use of LeLack Construction.

The undersigned certifies that the information provided herein is a clear and accurate representation of this organization. Information Supplied by:

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