Sub Contractor’s Pre Qualification Form

Firm Name (required) (Full Legal Name Required)

Trade/Service

Address

Estimating Point of Contact

Phone

Fax

Cell

Your Email (required)

CT DAS Prequalifications

Federal Set Aside Designation

State of Connecticut Set Aside Designation

Type

Please attach SBE/MBE Certificate.

Please attach list of last 5 significant projects with your contract amount.

Latest Experience Modification Rate

Name of Authorized Signatory

Authorized Signatory's Contact Information

Please type the letters and numbers you see into the box.
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