Subcontractors Company All subcontractors working for Edwards-Rigdon Construction Company are required to complete this questionnaire. The contents of this questionnaire are confidential and used solely to determine the subcontractors qualification.General Information Business Name * Contact Name * Title * Address * City * Email * Phone * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * Fax Trade Description(s) * Organization Business Type * Corporation Partnership Limited Liability Company Sole Proprietor Other Operation Type Non-Union Union Both Check all options that your business qualifies for. DBE MBE SBE WBE Has your business conducted operations under another name? No Yes Is your business owned or controlled by a parent or any other organization? * No Yes Please provide the full name and title of all officers, managers and principals of your business. Work experience Has your firm or any other organization with which your officers or owners were involved during the past three (3) years, ever failed to complete any work awarded or been terminated for cause? * No Yes Are there any judgments, claims, arbitration proceedings, or suits pending/out-standing against your firm or its officers or principals? * No Yes Has your firm filed any lawsuits or requested arbitration or mediation with regard to construction contracts within the last three (3) years? * No Yes What type of work does your firm typically subcontract to others? * Client Reference 1Client Reference 2 Client Name Client Phone Contract Amount ($) Project Description Client Name Client Phone Contract Amount ($) Project Description Safety and Health What is your business experience modification rate (EMR) for the last three (3) years? * Has your firm had any OSHA fines or jobsite fatalities within the last three (3) years? * No Yes Do you have a hazardous communication plan? * No Yes Do you have a drug testing program? * No Yes Do you have a full-time safety representative? * No Yes Do you have a written Safety Program? * No Yes Do you have a light duty program? * No Yes Are you Approved to work at I.U. Health? No Yes Additional Information Please provide any additional information you feel will help us determine your firm’s qualifications and expertise, including owner or general contractor references, etc. I hereby certify that I am authorized to submit this form on behalf of the organization and that the submitted information is accurate, correct and true.