| Thank you for your interest in working with Stronghold Engineering, Inc. This form will provide Stronghold with information regarding your company’s capabilities. |
| 1. Company Name |
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| 2. Type Of Service or Product Provided |
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| 3. Address |
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| 4. City |
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| 5. State |
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| 6. Zip |
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| 7. Contact Person |
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| 8. Email |
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| 9. Phone |
()
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| 10. Fax |
()
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| 11. Website |
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| 12. Company Annual Sales |
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If you have difficulty ascertaining your size status, please refer to SBA's website at
http://www.sba.gov or contact your local SBA office. |
| 13. Size of company |
Large Business (including non-profit)
Certified by SBA as a Small Disadvantaged Business
Certified by SBA as an 8(a) Business
Certified by SBA as a HUBZone Small Business
Woman Owned Small Business
Veteran Owned Small Business
Service Disabled Veteran Owned Small Business
Minority Institution or Historically Black College/University
Small Business
Other: Specify |
| 14. Primary NAICS Code |
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| 15. Number of Employees |
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| 16. Does your company have a Safety Policy and Program? |
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| 17. Contractor License Number |
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| 18. Issuing State |
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| 19. Type |
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| 20. Expires |
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| 21. Average Annual Volume of Work |
$ |
| 22. Bonding Capacity Per Job |
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| 23. Aggregate |
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| 24. Region / area(s) your company is interested in doing business |
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| 25. Have you conducted business with Stronghold Engineering, Inc. in the past? |
Yes No |
| 26. List completed project examples including completion date, owner, reference contact, contract amount and work performed. |
| Completion Date |
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| Owner |
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| Reference Contact |
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| Contract Amount |
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| Work Performed |
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| Completion Date |
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| Owner |
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| Reference Contact |
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| Contract Amount |
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| Work Performed |
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| Completion Date |
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| Owner |
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| Reference Contact |
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| Contract Amount |
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| Work Performed |
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| 27. Your Company's Contract Size Capabilities: (check all that apply) |
Under $100,000
$100,000-$200,000
$200,000-$500,000
$500,000-$1,000,000
$1,000,000-$3,000,000
$3,000,000-$6,000,000
$6,000,000-$10,000,000
$10,000,000-$15,000,000
Over $15,000,000
Other: $ |
| 28. Has your Company ever been terminated for default on any Contract? |
Yes
No |
| 29. Has your Company ever been disbarred from doing business with any governmental agency? |
Yes
No |
| 30. Comments |
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| 31. Certification and Privacy Notice |
Stronghold Engineering, Inc. will review the information furnished, but is relying upon your Company to furnish Stronghold Engineering with truthful and accurate information. Accordingly,
to the best of the Company's knowledge as of the date of this Prequalification Submission, the information contained herein is truthful, accurate and current. Your Company further understands
that by submitting this form, Stronghold Engineering does not guarantee or promise any work to your Company, nor should this be construed to be an offer of any work. The purpose of this
submission is prequalification only. Your Company also understands that the information provided is not intended to be confidential or private, and it shall not be treated as such. |
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