New South Synergy, JV Subcontractor Prequalification Form
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COMPANY CONTACT INFORMATION
What is your legal business name? *
Please enter your company name as it is registered with the State.
Are you DBA (doing business as) another name? *
How many years have you been in business as a subcontractor? *
Company's Principal office address *
Primary Contact *
Total Number of Employees *
Certifications - List any of the following certifications along with the certification number(s) and exipration date(s): AABE, FBE, HABE, AP/ABE, 8A, HUBZone, Native American 8A, NWBOC, SBE, SDVOSB, VOSB, WOSB, MBE, DBE, or any other certification. *
Claims / Safety
Experience Modification Rate (EMR) - Current *
Experience Modification Rate (EMR) - 2019 *
OSHA Total Recordable Frequency Rate - 2020 *
OSHA Total Recordable Frequency Rate - 2019 *
Have you had any OSHA violations in the last 5 years? *
List any OSHA Violation Dates and Descriptions in the last 5 years: *
Does your company have a safety manager / director? *
Work Experience
Typical Trades performed *
Percentage of work that is self-performed *
Union affiliation, if any *
List each category of work, if any, that the company typically self performs. *
Average size of contracts *
Have you previously or are you currently working on any MARTA projects.  If so, please list the project name(s) and date. *
Have you previously or are you currently working on any Hartsfield Jackson International Airport (HJIA) projects.  If so, please list the project name(s) and date. *
List your three largest projects completed, name, year, and contract amount - #1 *
List your three largest projects completed, name, year, and contract amount - #2 *
List your three largest projects completed, name, year, and contract amount - #3 *
Total dollar value of all work currently under contract *
Total dollar value of all work currently in progress *
Total dollar value of all work completed within the past year *
Refernces
Include 3 general contractor references, including the company name, telephone number, and person having the most knowledge of your dealings with their organization over the last 5 years. - #1 *
Include 3 general contractor references, including the company name, telephone number, and person having the most knowledge of your dealings with their organization over the last 5 years. - #2 *
Include 3 general contractor references, including the company name, telephone number, and person having the most knowledge of your dealings with their organization over the last 5 years. - #3 *
Include 2 trade contractor references, including the company name, telephone number, and person having the most knowledge of your dealings with their organization over the last 5 years. - #1 *
Include 2 trade contractor references, including the company name, telephone number, and person having the most knowledge of your dealings with their organization over the last 5 years. - #2 *
Untitled Title
By submitting this form, the submitting Company (and related entities) hereby certifies and swears that the information contained herein and attached hereto, and all documents and other information provided as requested herein, is true, complete, and correct on and as of the date hereof. If such information is not true, complete, and correct, in addition to all other remedies available to it, New South Construction Company or any joint venture or other New South entity may terminate any contract, purchase order, purchase agreement, or other agreement with the undersigned and such termination shall be considered a for cause termination. Any misrepresentations provided shall be considered fraudulent inducement in and to any subsequently executed subcontract.
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