Subcontractors Order Number 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 * Operation Type Non-Union Union Both Check all options that your business qualifies for. DBE MBE SBE WBE Contact Name * Email * Phone * Title * Address * City * 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) * 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 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. Agree To Terms 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.