Thank you for expressing an interest in working on future projects with us. Please fill out this form to
prequalify with Wolverine Fire Protection Co. This is an annual process. Submitting your completed form
with attachments will get your firm added to our corporate database for future consideration of work. 


GENERAL INFORMATION

Name Fed. ID #
Address
City, State, Zip
Phone Fax
email Website
Corporation LLC Partnership Sole Proprietor

TRADE

GEOGRAPHICAL LOCATIONS
Nationwide or list states:
BUSINESS INTEREST
INFORMATION
 		(Please check all that apply, must be at least small/large)

Minority Owned
Women Owned
Veteran Owned
HUB Zone

SDVOSB
8a
Small Business
Large Business
Tribal 8a

INSURANCE, BONDING
AND OTHER INFORMATION 		Are you an Equal Opportunity Employer? Yes No
Do you currently participate in E-Verify? Yes No

  Liability Insurance Carrier
Worker's Comensation Carrier
Are you bondable? Yes No
If yes, name of Surety Company
Capacity?
Per Job Aggregate

SAFETY INFORMATION
 		Year EMR
Year EMR
Year EMR

Please attach EMR Verification Letter

Do you have a written Safety Policy? Yes No
If yes, please attach Table of Contents.

FINANCIAL INFORMATION

 Annual Sales
Year $
Year $
Year $

Current backlog
Current number of employees
Have you ever failed to complete work awarded to you? Yes No
If yes, please comment:

Are you listed in Dunn and Bradstreet? Yes No
If yes, what is your number? What is your rating?

QUALITY CONTROL
PROGRAM INFORMATION 		Do you have a written Quality Control Program?
ISO Registered Yes No
NQA1 Certified Yes No
Other Yes No
Description:


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