subcontractor form

Company Name

Owner

Phone

Date

Address

City

ZIP

Do you Maintain General Liability Insurance?

Yes No

What kind of service your company provides?

Do you maintain worker's comp insurance? (not required in the state of TX)

Yes No

Reference 1 - Company Name

Contact

Phone

Project Type

Reference 2 - Company Name

Contact

Phone

Project Type

Reference 3 - Company Name

Contact

Phone

Project Type

Company Type

Company Website

Did your company change its name in the past 12 months?

Yes No

If so, please state the previous name

Number of employees

What is your geographical area of service?

Is there any type of work that you would prefer to avoid?

Additional Information: