Get Prequalified Get Prequalified We ask all subcontractors or suppliers that have not bid or completed work with Westland, to fill out the following form Company Name Organization type Corporation Partnership Sole Proprietor LLS Joint Venture Other (Specify) Address City State Zip Code Office Phone Office Fax Email Federal Tax ID Dunn & Bradstreet Number Rating How many years has your company operated under the name listed above? Do you operate under any other business name? (If yes, explain) List any other names you may have operated business under What type(s) of work does your company perform? Utah Contractor’s License Number Are you licensed to work in any other states? (If yes, list the State & License Number) Work you normally subcontract to others Are you a signatory to any labor agreements? (If yes, please list) B. PersonnelPlease list your Buisiness Owners & Key Officers Info: (Name, Position, Yrs. in Position) Number of Employee's in office Number of Employee's on field Trade References: (List atleast four, with following information: NAME, LOCATION, TITLE, PHONE Number) C. Safety & QualityWorkers Compensation experience modification rate for the previous 3 years Last Year Two Years Three Years Name of person in charge of company safety program Do you have a written safety plan? Yes No Explain your company's quality assurance program D. InsuranceWhat are the limits of the following insurance you carry: Each Occurance General Aggregate Products Completed Aggregate Personal & Bodily Injury Do you have a written safety plan? Yes No Submit
