Pre-Qualification Form - Hurley Construction

Other Locations

If you would like to add additional locations, provide their information below. Add or remove locations by clicking the “Add” or “Remove” shown below.

Address

City

State/Province

Zip/Postal

Contact Name

Title

Phone Number

Fax Number

Email

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Primary Contact

Name *

Title *

Email *

Phone *

Cell Phone

Additional Contacts

If you would like to add additional contacts, please provide their information below. Add or remove contacts by clicking the “Add” or “Remove” shown below.

Name

Title

Email

Phone

Cell Phone

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Trades Performed

Please List All Applicable Trades Performed *

States Licensed In

Areas of Work

Please Select All That Apply

Washington

North Seattle

South Puget Sound

Central / Eastern

All Washington

Oregon

Metro PDX

Central / Eastern

Southern Oregon

All Oregon

Additional (Please List)

Company Function

Please Select Any Applicable Company Functions *

Sub-Contractor

Manufacturer

Supplier

Preferred or Previous Structure Types Worked

Preferred Work Types

Please Select Any Applicable Preferred Work Types *

New

Tennant Improvements

Alterations/Rennovations

Bidding Information: Scope of Work Checklist

Please Select All That Apply

Div. 1: General Construction

01-020 Surveyor

01-030 Testing & Inspections

01-170 Debris Removal

01-190 Security Fence

Div. 3: Concrete

Div. 4: Masonry

04-010 Masonry Supply

04-020 Masonry Labor

04-030 Masonry Rebar

Div. 5: Metals

Div. 6: Wood & Plastics

Div. 10: Specialties

Div. 11: Equipment

11-010 Dock Equipment

11-024 Security/Emerg. Equip.

11-040 Kitchen Equip.

Div. 12: Furnishings

12-010 Awnings

12-050 Window Treatments

Div. 14: Conveyor Systems

14-010 Elevator

14-020 Scaffolding

Div. 15: Mechanical

15-010 Plumbing

15-020 Fire Sprinklers

15-030 HVAC

Div. 16: Electrical

16-710 Alarm & Detection

16-010 Electrical

Additional Scope

Preferred Project Size

Select Project Amount(s) *

Annual Volume of Work ($) *

Labor Affiliations

Please Select Any Applicable Labor Affiliation(s) *

Union

Non-Union

Prevailing Wage

Business Certifications

Please Select Certifications

Minority Business Enterprise (MBE)

Woman Business Enterprise (WBE)

Small Business Enterprise (SBE)

Disadvantaged Business Enterprise (DBE)

Local Business Enterprise (LBE)

Veterans Business Enterprise (VBE)

Disabled Veterans Enterprise (DVBE)

OtherOther

Attach documentation from any local, state or federal agency that has certified your company:

Maximum file size: 10MB

Projects Recently Completed

Project 1

Name *

Location *

Contract Amount ($) *

Owner/CM/GM *

Date Completed *

Project 2

Name *

Location *

Contract Amount ($) *

Owner/CM/GM *

Date Completed *

Insurance Requirements

Proof of Workers Compensation coverage (WA L&I account # or Cert of Workers Comp insurance ‐ all other states)
Washington Unified Business Identifier (UBI) number (Washington companies)
Completed Form W‐9 – Request for Taxpayer Identification Number
State Contractor’s License Pocket Card with expiration date
Certificate of Insurance: Talents Construction, LLC. must be named as additional insured on the certificate, indicating “all operations”, with a copy of endorsement attached to Certificate of Insurance.
1. Commercial General Liability:
  1. General Aggregate – (2,000,000)
  2. Products Aggregate – (2,000,000)
  3. Each Occurrence – (1,000,000)
  4. Personal & Advertising Injury – (1,000,000)
  5. Fire Legal Liability – (50,000)
  6. Medical Payments – (5,000)
2. Automobile Liability (Combined Single Limit) – (1,000,000)
3. Umbrella/Excess Liability – (1,000,000)
4. Professional Liability (if applicable) – (1,000,000)

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Form Completed By *

Title *

Date *

Signature

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Company Information

Other Locations

Primary Contact

Additional Contacts

Trades Performed

States Licensed In

Areas of Work

Company Function

Preferred or Previous Structure Types Worked

Preferred Work Types

Bidding Information: Scope of Work Checklist

Preferred Project Size

Labor Affiliations

Business Certifications

Projects Recently Completed

Insurance Requirements

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