Subcontractor Application Form

PARTNER PORTAL

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Subcontractor
Prequalification Form

Are you already working with SilMan? *

Who is your SilMan Team Member contact?

First

Last

Company Name, including DBA *

Office Address *

Address Line 1

Address Line 2

City

State

Zip Code

Office Phone *

Office Fax

Primary Contact *

First

Last

Email *

Phone *

AR Contact *

First

Last

Email *

Phone *

Remit To Address: *

Address Line 1

Address Line 2

City

State

Zip Code

About Your Company

Business Structure (Corp, LLC, etc.)

Trades (Concrete, Fire Sprinklers, etc.) *

Union Affiliation(s) *

Will you self-perform all work if contracted? *

What is the main reason for pre-qualifying with SilMan? *

Ex: Bidding a single project, bidding several projects, wish to be an approved SilMan Partner, all the above, or explain.

Which worksite(s) and project(s) are you bidding on? *

Please indicate "N/A" if not bidding.

If bidding, what will be your primary scope of work (or services provided) on this project? *

Please indicate "N/A" if not bidding.

Business/Contractors License(s). Provide numbers and states *

Do you have any Specialty Licenses?

If "yes," please list and upload a copy.

Upload a copy Specialty License(s).

Drag & Drop Files, Choose Files to Upload

Does your business have any Federal, State, or Local Program Designations or Certifications?

If yes, check all that apply.

Disabled Owned
Disabled Veteran Business Enterprise (DVBE)
Disadvantaged Business Enterprise (DBE)
Disadvantaged Veteran Enterprise (DVE)
HUBZone Certified
Minority Business Enterprise (MBE)
Service-Disabled Veteran (SDV)
Small Business
Small Disadvantaged Business (SDB)
Veteran Business Enterprise (VBE)
Woman Business Enterprise (WBE)
8(A) Designation
Other (list below)

If "Other" was selected above, please list below.

Upload copies of Federal, State and Local Programs, Designations, and Certifications.

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Environmental, Health, and Safety (EH&S) Safety Record (Part 1)

Do you have a dedicated full-time EH&S Director or a Site Safety Manager? *

EH&S Manager Contact Information

First

Last

Phone

If you do not have a dedicated EH&S Director or Safety Manager, who is primarily responsible for Safety?

First

Last

Phone

Safety Record (Part 2): Safety Data for the Past 3 Years

Safety data refers to (select one): *

Companywide
Establishment

2023

Were you in business in 2023? *

EMR (WCIRB Experience Modification Rate)

Total hours worked by all employees

Total # of OSHA Recordable Cases

Total # of cases of days away from work, restricted or transfer of duty

Total # of fatalities

2024

Were you in business in 2024? *

EMR (WCIRB Experience Modification Rate)

Total hours worked by all employees

Total # of OSHA Recordable Cases

Total # of cases of days away from work, restricted or transfer of duty

Total # of fatalities

2025

Were you in business in 2025? *

EMR (WCIRB Experience Modification Rate)

Total hours worked by all employees

Total # of OSHA Recordable Cases

Total # of cases of days away from work, restricted or transfer of duty

Total # of fatalities

Safety Record (Part 3)

Have you been issued any OSHA/EPA citations within the past 5 years? *

Do you currently have any open or ongoing investigations? *

If you answered “YES” to any of the above two questions, please explain.

Do you have a written Safety & Health Manual? Or, if operating in CA, a written IIPP? *

Do you have a written Code of Safe Practices / S.O.P.? (submit current copies for review) *

Reminder: you will be asked to submit all current documents for “yes” responses at the end of this form.

Safety Record (Part 4)

Do you have written EH&S Policies or Programs applicable for your scopes of work? (Example: If contracted to perform Excavation work your company must have written programs in Excavation/Trenching, Fall Protection and Confined Space, as they may be integrally related. If yes, submit ALL programs and policies applicable to your work.) *

Do you have a safety plan and procedure for recognizing hazards prior to work? ALL companies are required to submit a Pre-Task Plan/JHA/JSA for each task, before commencing work. *

Do you conduct periodic Jobsite Safety Audits? *

Frequency

Do you hold "Toolbox" safety meetings for your employees? *

Frequency

Are your Mobile Equipment Operators certified, trained and authorized to operate equipment? If yes, you may be asked to submit current proof of training for each operator and equipment type. *

Reminder: you will be asked to submit all current documents for “yes” responses at the end of this form.

Form submitted by *

First

Last

Date

Submittal Items: Please submit the following documentation applicable to your organization or when specifically requested.

W-9 IRS Form (current Request for Taxpayer Identification Number and Certification) *

Drag & Drop Files, Choose Files to Upload You can upload up to 4 files.

S&H Manual, IIPP, Code of Safe Practices (including all relevant EH&S Programs & Policies) *

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

Certificate of Liability Insurance (COLI) (Either “Evidence of Insurance” or a “project-specific” COLI may be requested) *

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

You may also provide other relevant documents.

For example: Bonding capacity certification, EMR Letter, OSHA 300A logs, JHA, awards/recognition, etc.

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

Comment

SUBCONTRACTOR PREQUALIFICATION

Subcontractor Prequalification Form

About Your Company

Environmental, Health, and Safety (EH&S) Safety Record (Part 1)

Safety Record (Part 2): Safety Data for the Past 3 Years

2023

2024

2025

Safety Record (Part 3)

Reminder: you will be asked to submit all current documents for “yes” responses at the end of this form.

Safety Record (Part 4)

Reminder: you will be asked to submit all current documents for “yes” responses at the end of this form.

Submittal Items: Please submit the following documentation applicable to your organization or when specifically requested.

You may also provide other relevant documents.

Subcontractor
Prequalification Form