SUPPLIER PREQUALIFICATION QUESTIONNAIRE

Conway, AR | Little Rock, AR | Jonesboro, AR | Fort Smith, AR | Rogers, AR | Springfield, MO | Lenexa, KS | Tulsa, OK | Oklahoma City, OK | Olive Branch, MS
nabholz.com | 1-877-NABHOLZ
Dear Supplier:
To better maintain your company information in our database, we are providing you with the attached Supplier Prequalification Questionnaire along with these instructions, to update your Company Setup information on an annual basis. Please complete the attached Supplier Prequalification Form in its entirety and return to one of the procurement coordinators listed on the signature page of the form. All information will be held in strict confidence within the Nabholz family of companies and will be utilized for in-house analysis of qualification. Along with completing the Supplier Prequalification form we request that you provide the following list of documents for review by our supply chain review team.
Additionally, any Supplier whose purchase order is anticipated to be greater than $1,000,000 shall also submit the following financial information:
Letter of good standing from surety providing years of relationship, verification of bond rate, and single project and aggregate surety limits. Letter must also include the Surety’s A.M. Best Rating
Accord 25 Certificate of Liability Insurance in compliance with the attached Sample.
Litigation Disclosure; explaining any suspensions, denials, revocations, petitions for bankruptcy, contract terminations, judgments, liens, claims, arbitration proceedings in which your firm has filed or been a party to.
OSHA 300/300A logs last three (3) years
Current Work In Progress Report
Reference letter from bank officer stating line of credit, basis extended, how much unsecured and secured, what security required, overall banking relationship, and years of relationship
Current year-end financial statement (audited or reviewed)
Thank you for your participation in this Company maintenance effort. Nabholz owes its long history of successful business to successful relationships with clients, subcontractors, and suppliers. And we look forward to building a successful relationship with your firm as well.
Sincerely,
Nabholz Construction Corporation
Revised: 11/12/2015 1
Main Contact:
Title: E-mail:
Classifications Bonding and Insurance
WBE – Women-owned MBE – Minority DBE – Disadvantaged VBE – Veteran SBE – Small Business State Classification Federal Classification Other Classification
Other Class Description:
Classification Certified By:
Bondable Bonding Company:
Insurance Contact:
Insurance Tel:
Explain any work that your firm or any affiliated firm has had completed or supported by a surety.
Check if none
What is your bond premium rate? If it is a tiered rate, please list tiers.
Revised: 11/12/2015 2
III. Divisions of Work
CSI – Description CSI – Description
01-5526 - Traffic Control
01-5626 - Temporary Fencing
05-1300 - Stainless Steel
06-1753 - Shop-Fabricated Wood Trusses
07-7200 - Roof Accessories
07-7600 - Roof Pavers
07-9500 - Expansion Control
08-1400 - Wood Doors
08-1500 - Plastic Doors
08-4500 - Translucent Wall and Roof Assemblies
08-5100 - Metal Windows
08-5200 - Wood Windows
08-6200 - Unit Skylights
08-6700 - Finish Hardware
10-2219 - Demountable Partitions
10-2226 - Operable Partitions
10-2800 - Toilet, Bath and Laundry Accessories
10-3200 - Fireplace Accessories
10-7500 - Flagpoles
11-3100 - Residential Appliances
11-4000 - Foodservice Equipment
11-5200 - Audio-Visual Equipment
11-5213 - Projection Screens
11-5300 - Laboratory Equipment
11-6600 - Athletic Equipment
11-7000 - Healthcare Equipment
11-9100 - Religious Equipment
12-9300 - Site Furnishings
Revised: 11/12/2015 3
St Code – City St Code – City St Code – City
Revised: 11/12/2015 4
Business Type: Years in Business No. of Employees
State of Formation Date Established Dun & Brad No. D & B Rating
Principals Fictitious [Trade or dba] Names
List Business Owners and Key Officers
Name, Title – Yrs. in Position
List any fictitious [trade or dba] names or affiliate companies under which your firm operates
Litigation Information:
Explain any [petitions for bankruptcy] that your firm or any affiliated firm or any of your owners, officers or principals has filed. Check if none
Explain any [failure to complete] or [termination for cause] that your firm or any other organization with which your owners, officers or principals were involved with during the past 5 years. Check if none
Explain any judgments, liens, claims, arbitration proceedings, or suits pending/ outstanding against your firm or its owners, officers or principals. Check if none
Explain any lawsuits or requested arbitration or mediation with regard to purchase orders that your firm has filed or been the subject of within the past three years. Check if none
Revised: 11/12/2015 5
OWNERS:
GENERAL CONTRACTORS:
SUBCONTRACTORS:
SUPPLIERS:
Revised: 11/12/2015 6
Conway, AR | Little Rock, AR | Jonesboro, AR | Fort Smith, AR | Rogers, AR | Springfield, MO | Lenexa, KS | Tulsa, OK | Oklahoma City, OK | Olive Branch,
MS nabholz.com | 1-877-NABHOLZ
By executing below, I am acknowledging that Nabholz Construction and the Owner will be relying upon the accuracy of this above information to assist them in determining in their discretion whether any organization can be selected bidder for individual work categories or combined work categories as established in the bid documents.
I understand the questions above and have answered truthfully and to the best of my knowledge.
Name: Title:
Signature: ____________________________________ Date:
Revised: 11/12/2015 7
Nabholz Construction Services Central Region Rogers, AR Attn: Sherry Glanton 3301 N 2nd Street Rogers, AR 72756 (479) 659-7874 [email protected]
Nabholz Construction Services Central Region Springfield, MO Attn: Janna Smalley 2223 W Sunset St Springfield, MO 65807 (417) 450-6016 [email protected]
Nabholz Construction Services South Region Conway, AR Fort Smith, AR Jonesboro, AR Little Rock, AR Olive Branch, MS Attn: Sarah McMillian 612 Garland Street Conway, AR 72032 (501) 505-5829 [email protected]
Nabholz Construction Services Midwest Region Olathe, KS Attn: Jamie Lancaster 17300 W 116th St Lenexa, KS 66219 (913) 393-6518 [email protected]
Nabholz Construction Services Southwest Region Tulsa, OK Attn: Deanna Bowman 10319 East 54th Street Tulsa, OK 74146 (918) 632-7214 [email protected]
Nabholz Construction Services Southwest Region Oklahoma City, OK Attn: Cheryl Lowe 6400 South Superior Ave. Oklahoma City, OK 73149 (405) 979-4400 [email protected]
Litigation Disclosure explaining any suspensions denials revocations petitions for bankruptcy contract terminations: Off
OSHA 300300A logs last three 3 years: Off
Current Work In Progress Report: Off
Reference letter from bank officer stating line of credit basis extended how much unsecured and secured what security: Off
Current yearend financial statement audited or reviewed: Off
WBE Womenowned: Off
MBE Minority: Off
DBE Disadvantaged: Off
VBE Veteran: Off
015526 Traffic Control: Off
015626 Temporary Fencing: Off
032100 Reinforcement Bars: Off
032205 Wire Mesh: Off
032400 Fibrous Reinforcing: Off
033010 Caissons: Off
051300 Stainless Steel: Off
055000 Metal Fabrications: Off
057000 Decorative Metal: Off
061753 ShopFabricated Wood Trusses: Off
061800 GluedLaminated Construction: Off
076000 Flashing and Sheet Metal: Off
077200 Roof Accessories: Off
077600 Roof Pavers: Off
079500 Expansion Control: Off
081400 Wood Doors: Off
081500 Plastic Doors: Off
084500 Translucent Wall and Roof Assemblies: Off
085100 Metal Windows: Off
085200 Wood Windows: Off
086200 Unit Skylights: Off
086700 Finish Hardware: Off
101400 Signage: Off
101416 Plaques: Off
102219 Demountable Partitions: Off
102226 Operable Partitions: Off
102800 Toilet Bath and Laundry Accessories: Off
103200 Fireplace Accessories: Off
105100 Lockers: Off
107500 Flagpoles: Off
112300 Laundry and Dry Cleaning Equipment: Off
113100 Residential Appliances: Off
114000 Foodservice Equipment: Off
115200 AudioVisual Equipment: Off
115213 Projection Screens: Off
115300 Laboratory Equipment: Off
116600 Athletic Equipment: Off
117000 Healthcare Equipment: Off
119100 Religious Equipment: Off
124813 Entrance Floor Mats and Frames: Off
129300 Site Furnishings: Off
Petitions for Bankruptcy:
Judgments, Leins, Claims, etc:
No failure to complete / termination for cause: Off
No judgments, liens, claims, etc:
pending/outstanding: Off
No lawsuits or requested arbitration/mediation RE PO's w/in past 3 yrs: Off
Lawsuits or requested arbitration/mediation RE PO's w/in past 3 yrs:
No work completed/supported by surety: Off
Work completed/supported by surety:

Documents

SUPPLIER PREQUALIFICATION QUESTIONNAIRE