Subcontractor Qualify

Subcontractor Qualify

Block Construction, LLC a division of Block Companies, LLC, is a Equal Opportunity Employer.

If you are interested in joining the Block team as a Subcontractor and you have multi-family,

new-construction experience please complete the form below.

Thank you for your interest in Block Construction, LLC.

Business Name: *
Date:
Street Address: *
Mailing Address 1: *
Mailing Address 2:
State:
Zip Code: *	(5 digits)
Business Phone: *
Years at address: *
Years in business: *
Years under present name: *
Are you a D/M/WBE company:
	YOUR PERSONAL INFORMATION
YOUR First Name: *
YOUR Last Name: *
YOUR Address 1: *
YOUR Address 2:
State: *
Zip Code: *	(5 digits)
YOUR Email:
Please specify the type of work you perform or if you are a vendor what you supply: *
	PARTNER INFORMATION - List names of ALL partners
NAME - Partner 1:
ADDRESS - Partner 1:
NAME - Partner 2:
ADDRESS - Partner 2:
	Number of employees
Management: *
Administrative: *
Drafting: *
Field: *
	Bonding Information
Bonding Company: *	(Full Name)
Bonding Agent: *
Bonding Address 1: *
Bonding Address 2:
Bonding State:
Bonding Zip Code: *	(5 digits)
Bonding Phone: *
Agent Email:
Bonding Capacity: *
Bonding Rate: *	(%)
2012 Value of work: *
2011 Value of work: *
	Insurance Requirements
	Subcontractor shall before commencing any work to be conducted under a contract, furnish Block Construction, LLC with a Certificate of Insurance covering not less than the insurance required. Notwithstanding the foregoing, said coverage and limits shall always be subject to a minimum of.
	Commercial General Liability (please check each)
	$1,000,000 occurrence / $2,000,000 aggregate. **Commercial General Liability, "occurrence form" including contractual liability and products & completed operations.
	Worker's Compensation and Employer's Liability (please check each)
	$500,000 minimum coverage
	ALL subcontractor employees working on the project MUST be covered by the policy.
	Automobile Liability Insurance
	$1,000,000 minimum coverage
	Additional Insurance Requirements
	The owner may specify certain requirements in addition to and/or greater than than listed above within their contract. These requirements will be reflected within your contract. Make sure your Insurance exhibit is reviewed thoroughly before requesting a certificate of Insurance.
	Subcontractors must provide Block Construction, LLC with a certificate of insurance verifying his/her coverage within 10 days of receipt of contract. In addition, the subcontractor must provide an endorsement indicating that the owner which will be specified in your contract, Block Construction, LLC and any other specified parties have been listed as additionally insured on said policies as per the terms of the contract.
Coverage State 1:
Coverage State 2:
	By checking this box I am applying for subcontractor work with Block Builders, LLC and agree to supply Block Construction, LLC with any and all requested information and documentation.
Digital Signature: *	(Print name)

Block Construction is a division of Block Companies