Subcontractor Qualification Form

General Information

 

Information From the Past Three Years

 

Additional Business Information

 

Insurance

  • All subcontractors doing work for Polu Kai Services, LLC are required to have the following insurance coverage:

    Comprehensive General Liability including Blanket Contractual Liability: $1,000,000.00 combined Single Limit for bodily injury and property damage
    $2,000,000.00 Aggregate per project or location.
    Contractor shall be added as additional insured. Policy shall NOT contain fungi or bacterial agent exclusion and shall so state on Certificate of Insurance.

    Automotive Liability (Owned, leased and non‐owned vehicles):
    $1,000,000.00 Combined Single Limit for bodily injury and property damage.

    Workers Compensation and Employers Liability Coverage:
    Statutory Workers Compensation coverage
    Employers Liability ‐ $1,000,000.00 each accident / $1,000,000.00 each employee / $1,000,000.00 policy limit

    Umbrella Liability Coverage
    Limit of Liability: $2 million

    A)Your underwriters(s) must provide endorsements naming Polu Kai Services, LLC and the Client as additional insured’s on your Comprehensive Automobile and Vehicle Liability, Commercial General Liability and Contractor’s Pollution Liability insurances policies.

    B) Your underwriter(s) must provide policy endorsements waiving its rights of subrogation with respect to Polu Kai Services, LLC and the Client in connection with your Workers’ Compensation/Employer’s Liability; Comprehensive Automobile and Vehicle Liability; Commercial General Liability.

    C) Your underwriter(s) must provide a per-project-aggregate endorsement to your Commercial General Liability insurance policy.

    D) Your underwriter(s) must provide 30 days written notice to Polu Kai Services, LLC should any of the required insurance policies be canceled prior to their expiration date.
 

Previous Experience

  • List three projects you have recently completed at similar facilities(or other facilities, if three projects have no not been completed at similar facilities) involving work of a type and complexity similar to that of the subcontract work. Indicate cost and duration, and name, address, and telephone number of the project owner and client.
 

Bonding Capacity

 

References

 

Banking References

 

Authorization

  • The contractor further certifies that they will notify the Polu Kai Services, LLC Administrators of any changes to the information provided.
 

Certifications and Licenses

 

Security Verification