Prequalification Form

Note: Prior to completing this form, please scroll to the bottom to view the required documents that need to be uploaded with this form. Prequalification forms submitted without the required documents will not be considered.















































Check all that apply










Check all that apply















Check all that apply






























List any Bozzuto Group Projects you have worked on in the past three (3) years. If none, please state.





















Is your company or any of its owners or officers currently involved in any litigation, mediation, arbitration or prosecution or defense of formal claims in connection with any contract, project or subcontract?




Has your company or any affiliated company or any of its principals ever petitioned for bankruptcy, failed in business, closed a business, defaulted or failed to complete on a contract, or been asked to post collateral against a loss?





Please provide your company’s EMR for the last three (3) years









How many man-hours has your company worked in each of the last three (3) years?









How many OSHA Recordable Injuries did your company experience in each of the last three (3) years?









Has your company had a federal or state OSHA Citation within the last three (3) years?


How many of the following types of citations, if any, have you received?























How many Lost Time incidents/days away from work incidents has your company had in each of the last three (3) years?











Check all that apply

















Please list jurisdictions and license numbers where you hold licenses:





I have downloaded and read the sample subcontract agreement. I understand that this document is for informational purposes only and is not an offer to hire.
Download Link: https://drive.google.com/file/d/19g93VgbIso2tJNeJx_u1a1Nwfz1IUMAU/view?usp=sharing






Please upload all the required documents listed below in order to be considered for prequalification:

1. Certificate of Insurance
2. W9
3. EMR Rating Confirmation Letter
4. Bond
5. OSHA Form (Past 3 Years)
6. References (Attach a list of the following references, current as of the last three (3) years. Include Name, Phone Number, and length of relationship: Two (2) of largest suppliers; Bank; and Project/Work.)
7. List of COMPLETED Projects Past 3 Years. (Include: Client Name, Contact and Contract Value:)
8. List of IN PROGRESS Projects (with % completed and contract amounts.)
9. Comments on Subcontract Agreement Sample. (See above section for sample link.)














It is recommended that you check the box below to receive a copy of your submissions. All additional forms should be emailed directly to Tamara Kaye, tkaye@bozzuto.com.






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