Qualification Agreement - Dondlinger Construction

Name of Firm

Firm Contact Email

Firm Phone Number

Firm Address

City

State

Zip Code

Union

Union Non Union

Tax ID Number

Date Founded

Years in Business

Trade Description/Business Type

Total Employees

Office Total

Field Total

Please Submit a current W-9

Firm EIN

Main Contact Person

Title

Years in Position

License Type and Numbers:

Total Bonding Capacity

Bonding Company

Value of Current Work Bonded

Bond Rate

Agent

Agent Phone Number

Subcontractor's General Liability Limit

Subcontractor's Auto Limit

Subcontractor's Umbrella Limit

Subcontractor's Worker's Comp Limit

${ parent.decodeEntities(`Date`) } <${props.Flatpickr} name="mf-date" className="mf-input mf-date-input mf-left-parent " placeholder="${ parent.decodeEntities(`Date`) } " options=${{"minDate":"today","maxDate":"","dateFormat":"m-d-Y","enableTime":"","disable":[],"mode":"single","static":true,"disableMobile":true,"time_24hr":false}} value=${parent.getValue('mf-date')} onInput=${parent.handleDateTime} aria-invalid=${validation.errors['mf-date'] ? 'true' : 'false'} ref=${el => props.DateWidget( el, '', {"message":"This field is required.","required":false}, register, parent )} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-date" as=${html``} />

${ parent.decodeEntities(`Name Of Firm`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="firm-name" as=${html``} />

${ parent.decodeEntities(`Address of Firm`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-address" as=${html``} />

${ parent.decodeEntities(`City`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-city" as=${html``} />

${ parent.decodeEntities(`State`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-state" as=${html``} />

${ parent.decodeEntities(`Zip`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="zip" as=${html``} />

${ parent.decodeEntities(`Telephone`) } parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-telephone" as=${html``} />

${ parent.decodeEntities(`Fax`) } parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-fax" as=${html``} />

${ parent.decodeEntities(`URL`) } parent.activateValidation({"message":"This field is required.","urlMessage":"Please enter a valid URL starting with http:\/\/ or https:\/\/","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-url" as=${html``} />

${ parent.decodeEntities(`Union`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'union' === parent.getValue('mf-radio')} /> ${ parent.decodeEntities(`Union`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'non-union' === parent.getValue('mf-radio')} /> ${ parent.decodeEntities(`Non-Union`) }

<${validation.ErrorMessage} errors=${validation.errors} name="mf-radio" as=${html``} />

${ parent.decodeEntities(`Tax ID Number`) } parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-tax-id" as=${html``} />

${ parent.decodeEntities(`Date Founded`) } <${props.Flatpickr} name="mf-date-founded" className="mf-input mf-date-input mf-left-parent " placeholder="${ parent.decodeEntities(`Date`) } " options=${{"minDate":"","maxDate":"","dateFormat":"m-d-Y","enableTime":"","disable":[],"mode":"single","static":true,"disableMobile":true,"time_24hr":false}} value=${parent.getValue('mf-date-founded')} onInput=${parent.handleDateTime} aria-invalid=${validation.errors['mf-date-founded'] ? 'true' : 'false'} ref=${el => props.DateWidget( el, '', {"message":"This field is required.","required":false}, register, parent )} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-date-founded" as=${html``} />

${ parent.decodeEntities(`Years In Business`) } parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-years" as=${html``} />

${ parent.decodeEntities(`Total Employees`) } parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-employees" as=${html``} />

${ parent.decodeEntities(`Office Total`) } parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-office" as=${html``} />

${ parent.decodeEntities(`Field Total`) } parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-field" as=${html``} />

${ parent.decodeEntities(`Please Submit a current W-9`) }

parent.activateValidation({"message":"This field is required.","required":false,"file_types":[".jpg",".jpeg",".gif",".png"],"type_message":"Invalid file extension","size_limit":-1,"limit_message":"This field is required."}, el) } /> ${ parent.decodeEntities(`Upload File`) }

${ (parent.state.formData['mf-file-upload'] || []).length > 0 ? parent.state.formData['mf-file-upload'].map((file, idx) => html` ${file.name} parent.removeUploadedFile('mf-file-upload', idx)} title="Remove" > × `) : html`${parent.getFileLabel('mf-file-upload', 'No file chosen.')}` }

<${validation.ErrorMessage} errors=${validation.errors} name="mf-file-upload" as=${html``} />

${ parent.decodeEntities(`EIN`) } parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-EIN" as=${html``} />

${ parent.decodeEntities(`Main Contact Person`) } parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) } /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-listing-fname" as=${html``} />

${ parent.decodeEntities(`Title`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-title" as=${html``} />

${ parent.decodeEntities(`Years In Position`) } parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-years-in-position" as=${html``} />

${ parent.decodeEntities(`Email`) } parent.activateValidation({"message":"This field is required.","emailMessage":"Please enter a valid Email address","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-contact-email" as=${html``} />

${ parent.decodeEntities(`Total Bonding Capacity`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-capacity" as=${html``} />

${ parent.decodeEntities(`Bonding Company`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-bonding-company" as=${html``} />

${ parent.decodeEntities(`Value of Current Work Bonded`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-value" as=${html``} />

${ parent.decodeEntities(`Bond Rate`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-bonding-rate" as=${html``} />

${ parent.decodeEntities(`Agent`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-agent" as=${html``} />

${ parent.decodeEntities(`Agent Phone #`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-agent-phone" as=${html``} />

Dondlinger Insurance Requirements

General Liability – $2,000,000

Auto Insurance – $1,000,000

Umbrella Insurance – $1,000,000

Worker’s Comp – $500,000

${ parent.decodeEntities(`Subcontractor's General Liability Limit`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-GL-limit" as=${html``} />

${ parent.decodeEntities(`Subcontractor's Auto Limit`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-auto-limit" as=${html``} />

${ parent.decodeEntities(`Subcontractor's Umbrella Limit`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-umbrella-limit" as=${html``} />

${ parent.decodeEntities(`Subcontractor's Worker's Comp Limit`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-wc-limit" as=${html``} />

${ parent.decodeEntities(`Insurance Agent’s Name`) } <${validation.ErrorMessage} errors=${validation.errors} name="mf-Insurance-agent" as=${html``} /> ${ parent.decodeEntities(`Include address, phone number, contact person`) }

${ parent.decodeEntities(`Is Subcontractor registered as a DBE?`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'yes' === parent.getValue('mf-radio')} /> ${ parent.decodeEntities(`Yes`) }

{ parent.handleRadioDefault(el); parent.activateValidation({"message":"This field is required.","required":false}, el) }} checked=${'No' === parent.getValue('mf-radio')} /> ${ parent.decodeEntities(`No`) }

<${validation.ErrorMessage} errors=${validation.errors} name="mf-radio" as=${html``} />

${ parent.decodeEntities(`City & State certified in:`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-text" as=${html``} /> ${ parent.decodeEntities(`Please submit a copy of certification`) }

${ parent.decodeEntities(`Does Subcontractor have a written Safety Program?`) }

<${validation.ErrorMessage} errors=${validation.errors} name="mf-radio" as=${html``} />

${ parent.decodeEntities(`What is your current EMR Rating?`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-text" as=${html``} />

${ parent.decodeEntities(`Does your firm have a designated full time safety representative?`) }

<${validation.ErrorMessage} errors=${validation.errors} name="mf-radio" as=${html``} />

${ parent.decodeEntities(`If Yes, please provide name and contact number:`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-text" as=${html``} />

${ parent.decodeEntities(`Has your firm failed to complete a contract`) }

<${validation.ErrorMessage} errors=${validation.errors} name="mf-radio" as=${html``} />

${ parent.decodeEntities(`Has your firm been involved in bankruptcy or reorganization`) }

<${validation.ErrorMessage} errors=${validation.errors} name="mf-radio" as=${html``} />

${ parent.decodeEntities(`Do you have any pending judgments, claims or suits against firm?`) }

<${validation.ErrorMessage} errors=${validation.errors} name="mf-radio" as=${html``} />

${ parent.decodeEntities(`In the previous three years has your firm been cited for a serious (as defined by O.S.H.A.) violation?`) }

<${validation.ErrorMessage} errors=${validation.errors} name="mf-radio" as=${html``} />

${ parent.decodeEntities(`If yes, explain:`) } <${validation.ErrorMessage} errors=${validation.errors} name="mf-textarea" as=${html``} />

List three (3) significant projects your firm has completed in the last five (5) years.

Please include:

Project/Location
General Contractor
Subcontract Amount
Date Completed
Contact & Phone Number.

${ parent.decodeEntities(`1`) } <${validation.ErrorMessage} errors=${validation.errors} name="mf-textarea" as=${html``} />

${ parent.decodeEntities(`2`) } <${validation.ErrorMessage} errors=${validation.errors} name="mf-textarea" as=${html``} />

${ parent.decodeEntities(`3`) } <${validation.ErrorMessage} errors=${validation.errors} name="mf-textarea" as=${html``} />

List three (3) significant projects your firm presently has under construction:

Please include:

Project/Location
General Contractor
Subcontract Amount
Date Completed
Contact & Phone Number.

${ parent.decodeEntities(`1`) } <${validation.ErrorMessage} errors=${validation.errors} name="mf-textarea" as=${html``} />

${ parent.decodeEntities(`2`) } <${validation.ErrorMessage} errors=${validation.errors} name="mf-textarea" as=${html``} />

${ parent.decodeEntities(`3`) } <${validation.ErrorMessage} errors=${validation.errors} name="mf-textarea" as=${html``} />

This form must be submitted by an individual authorized to do so on behalf of the firm.

${ parent.decodeEntities(`Name`) } { parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el) }} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-text" as=${html``} />

${ parent.decodeEntities(`Date Submitted`) } <${props.Flatpickr} name="mf-date" className="mf-input mf-date-input mf-left-parent " placeholder="${ parent.decodeEntities(`Date`) } " options=${{"minDate":"","maxDate":"","dateFormat":"m-d-Y","enableTime":"","disable":[],"mode":"single","static":true,"disableMobile":true,"time_24hr":false}} value=${parent.getValue('mf-date')} onInput=${parent.handleDateTime} aria-invalid=${validation.errors['mf-date'] ? 'true' : 'false'} ref=${el => props.DateWidget( el, '', {"message":"This field is required.","required":false}, register, parent )} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-date" as=${html``} />

Dondlinger Insurance Requirements

This form must be submitted by an individual authorized to do so on behalf of the firm.

Contact Us

Corporate Office

Spring Hill Office