Vendor Pre-Qualification | U.S.A. General Industry Services

Important: Submission of this form does not guarantee approval, selection, contract award, purchase orders, or future business opportunities. Information submitted will be reviewed as part of the vendor pre-qualification process.

Vendor Information

Please provide complete and accurate company information. Fields marked with * are required.

Website

1. Company Information

Legal Company Name *

DBA / Trade Name

Primary Contact Name *

Title / Position

Email Address *

Phone Number *

Business Address *

City *

State *

ZIP Code *

Company Website

2. Business Information

Year Established

Number of Employees

Business Structure

Federal EIN / Tax ID

Products / Services Provided *

Geographic Service Area

3. Insurance & Business Requirements

General Liability Insurance

Workers' Compensation Insurance / Applicable Exemption

Commercial Automobile Insurance

Professional Liability / E&O, if applicable

Insurance Carrier

Policy Expiration Date

4. Safety & Performance Information

Written Safety Program

OSHA Citations During the Past 3 Years

If yes, please provide details.

Additional Qualifications, Certifications or Experience

5. Business References

Reference #1 Company

Reference #1 Contact

Reference #1 Phone / Email

Reference #2 Company

Reference #2 Contact

Reference #2 Phone / Email

6. Vendor Certification

By submitting this Vendor Pre-Qualification Form, I certify that the information provided is true and accurate to the best of my knowledge. I understand that submission does not constitute vendor approval, create a contractual relationship, guarantee work, or obligate U.S.A. General Industry Services to purchase products or services.

I certify that I am authorized to submit this information on behalf of the company and agree to the statement above. *

Authorized Representative *

Title *