Subcontractor Qualification Form

Instructions:

Please fill out the entire form.

Company Name

Address

City

State

Zip

Contact First Name

Contact Last Name

Phone

Fax

Cell

Website

Union Affiliation

Open Shop

Union

Trades Performed

How many years have you been in business?

Annual Volume? (in dollars)

What trades, if any, do you normally subcontract?

ACELLA INSURANCE REQUIREMENTS:

A job specific certificate will be required and it must reference the Project Name and Complete Address on the certificate.

1. Commercial General Liability: coverage with a minimum of:

a. $1,000,000 per occurrence
b. $100,000 damage to rented premises per occurrence
c. $1,000,000 personal & adv. Injury
d. $2,000,000 general aggregate
e. $2,000,000 products-comp/OP AGG

2. Autombile Liability $1,000,000

3. Excess Liability/Umbrella: All subcontractors must provide a minimum of $2,000,000 Excess Liability coverage.

4. Workers Compensation Coverage Provides statutory benefits, including employers liability coverage with minimum limits of:

$100,000/$500,000/$500,000

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