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Pre-qualified Contractor

  1. Organization Type
  2. Company's Bonding Limits
  3. References /Credentials
  4. Please list the county drain commissioners you are currently working for, or have worked for in the past 3 years, and contact person;
  5. Please list other municipalities/references you are currently working for, or have worked for in the past 3 years. and contact person;
  6. Please list any pre-qualifications you have, if any( i.e. MDOT, City of Adrian)
  7. Has your company ever failed to complete any work awarded to you? If so, where and why?
  8. Has any officer or partner of your organization ever been an officer or partner of some other organization that failed to complete a construction contract? If so, state name of individual, other organization, and reason for not completing contract (Attach a letter if needed)
  9. Drain Construction Abilities
    Please check the type of work your company has the equipment, manpower, and experience to complete:
  10. Enclosed Drain
  11. Open Drain
  12. Other
  13. List other areas of experience you believe would be applicable to drain maintenance:
  14. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  15. I, the undersigned, in applying to be placed on the Pre-Qualified Contractor’s List for non-petitioned maintenance, certify and attest that the above provided information is, to the best of my knowledge, true and accurate.
  16. Leave This Blank:

  17. This field is not part of the form submission.