Pre-Qualification Attachment I: Contractor Questionnaire

 I. Company Information  

Name of Business

Address (250 Char Limit)

Primary E-Mail

Alternate E-Mail

Please list your branch offices, if any, which are not actively engaged in construction work:

a.     b. 
c.    d. 
e.    f.  

Please list names of subsidiary or affiliated companies, if any:


 II. Organization  

A. Name and title of Corporate Officers/Partners:

Name Title

B.  Date Business Founded

C.  Annual Volume of Work          Contract value of largest job completed

D.  Indicate the job cost range which you prefer to do business:

     Minimum:         Maximum: 

E.  Permanent Personnel

Type Total Number
Supervision - Field
Supervision - Office

 III. Bidding Interest  

Indicate the classes of work you are interested in bidding.
Reference to Attachment IV.

Architectural Code Description NAICS Code


 IV. Labor Relations  

A.  List the total number of workmen which you hire directly by trade.
     Indicate Local or National Contracts.

Trade Number of People

B.  List the type of work your organization usually subcontracts to others:

Type Subcontractor Used Location

 V. References  

Indicate industrial and commercial projects completed within the past two years for each specific class of work listed in item III above. (minimum 3 per class)

Year Project &
Owner (or Prime Cotractor),
Address, Phone, &
Name of contact

 VI. Financial  

Attach last 5 fiscal years balance sheets (required).   


The balance sheet is in Excel format and can be found here.

 VII. Confirmation of Insurance Levels  

Click here to review terms and conditions for Construction and Labor Hour Contracts.  The Article entitled: "Insurance", displays the required insurance levels.  Click "Yes" or "no" if you meet the minimum requirements.

Insurance Type Yes No
General Liability Aggregate
Excess Liability Aggregate
Auto Liability Amount
Worker's Compensation

 VIII. Contractor Safety Record  

A.  Complete the Contractor Safety Record (Attachment II)

B.  Complete the Asbestos Exclusion Certification (Attachment III)


 _________________________               _________________________
         Company Name                                   Printed Name

 _________________________                _________________________

               Date                                                Signature

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Last Modified: September 25, 2012
Please forward all questions about this site to: John Collins


DOE, Office of Science One of ten national laboratories overseen and primarily funded by the Office of Science of the U.S. Department of Energy (DOE), Brookhaven National Laboratory conducts research in the physical, biomedical, and environmental sciences, as well as in energy technologies and national security. Brookhaven Lab also builds and operates major scientific facilities available to university, industry and government researchers. Brookhaven is operated and managed for DOE's Office of Science by Brookhaven Science Associates, a limited-liability company founded by the Research Foundation for the State University of New York on behalf of Stony Brook University, the largest academic user of Laboratory facilities, and Battelle, a nonprofit, applied science and technology organization.

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