Diversity

ELS recognizes that maintaining a diverse supplier pool is a major competitive advantage and a powerful business tool which provides agility and a new perspective to the services in which we provide. It is ELS’s objective to develop a diverse and inclusive team on our projects that will perform the highest quality work in a timely fashion for our clients.

Our ultimate goal is to maintain a world-class supplier diversity program that makes every effort to offer subcontracting opportunities to Disadvantaged/Minority/Women Business Enterprises (D/M/WBE’s).

Please complete our Supplier Pre-Qualification form below.

Company Name

Federal ID #

Contact Name

Title

Mailing Address

Street Address

City

State

Zip Code

E-mail

Phone

Fax

Cell

Company Website

Dun & Bradstreet Number (D&B)

What type of work does your company perform or what materials can your company supply?

Business type

If other please specify

How many years has your company been in operation?

Is your company located in other states?

If yes, please list the states in which you operate

Are there any judgments, claims, arbitration proceedings or suits pending/outstanding against your company and/or your owner?

If yes, please provide a detailed explanation

Has your company ever failed to complete work awarded or been terminated from a project within the last three (3) years?

If yes, please provide a detailed explanation

How many employees does your company employ?

Does your company perform background checks and drug screenings on your employees?

Check the size of work your company typically performs

What is the largest contract your company has completed?
Amount

Project Name and Scope

Annual revenue for the last three (3) years

2011

2012

2013

Is your company Union or Non-Union?

If Union, please list the following
Local Number

Union Name

Agreement Expiration

DISADVANTAGE/MINORITY/ WOMEN BUSINESS ENTERPRISE (D/M/WBE) INFORMATION

Please check all certifications that apply to your company

If other please specify

List Certifying Agency(s) and certificate number(s) in which you are affiliated with below (NAICS Codes: www.census.gov)

CERTIFYING AGENCY CERTIFICATE NO. EXPIRATION DATE

Has your company ever been involved in a Joint Venture or Teaming Agreement with another company?

LICENSING INFORMATION

Please provide all trades and professional licensing, if any, required to perform your service

Type of license State License number

BONDING AND INSURANCE INFORMATION

Bonding capacity for a single job?

Aggregate (Agg.) Bonding Capacity?

Who is your surety company?

Percent of work bonded

List your company’s insurance limits
General Liability

Each Occurrence / General Aggregate

Automobile Liability

Combined Single Limit
Excess Liability

Each Occurrence / Aggregate

Worker’s Compensation (Statutory)

SAFETY INFORMATION

Does your company provide OSHA training to its employees?

Describe your OSHA Citations (if applicable)

REFERENCES

List three references in which you have either performed work as a prime or subcontractor in the past three years

1. Company Name

Contact Person

Phone Number

E-mail address

Dollar Value of Work

Type of work performed

 

2. Company Name

Contact Person

Phone Number

E-mail address

Dollar Value of Work

Type of work performed

 

3. Company Name

Contact Person

Phone Number

E-mail address

Dollar Value of Work

Type of work performed