Project Name:	Elkhorn Fire Station
Company Information
*Name:
*Contact:
*Address:
*City:
*State:		*Zip:
*Phone:		Fax:
Company Contact Email:
* Required fields
Safety Information
What is your company's EMR?
What is your company's incidence rate?
Does your company have a safety manual?	Yes No
Does your company have a policy for wearing hard hats?	Yes No
Does your company have a policy for wearing safety glasses?	Yes No
Performance Information
Will your company be able to meet Schedule Requirements?	Yes No
Does your company currently have the manpower to meet these requirements?	Yes No
Will your company be subcontracting out any scope of the work?	Yes No
If so, list:
Experience in Design-Build   (list 3 past projects)
Project 1
Project Name:
Location:
Date Completed   YYYY-MM-DD:
Scope of Work:
Contract Amount:
Reference Contact:
Phone:
Email:
Project 2
Project Name:
Location:
Date Completed   YYYY-MM-DD:
Scope of Work:
Contract Amount:
Reference Contact:
Phone:
Email:
Project 3
Project Name:
Location:
Date Completed   YYYY-MM-DD:
Scope of Work:
Contract Amount:
Reference Contact:
Phone:
Email:
Additional Information
Please list any additional information you would like us to consider: