Contractor’s Qualification Statement

You can fill out this form online, or you can download the PDF and return your completed form to: Five Star Building Corp. | 17 East Street | Easthampton, MA 01020 | 413.587.4061 (Fax)

AIA Document A305: 1986 Edition

The Undersigned certifies under oath that the information provided herein is true and sufficiently complete so as not to be misleading.
Submitted To
Address
Submitted by(required)
Name(required)
Email(valid email required)
Address(required)
Principal Office
Business Type(required)
Name of Project (if applicable):
Type of Work (file or upload separate form for each Classification of Work):
General Construction
HVAC
Plumbing
Electrical
Other (please specify
Specify "Other"
Upload separate form for each Classification of Work
Upload separate form for each Classification of Work
Upload separate form for each Classification of Work

1. ORGANIZATION

1.1 How many years has your organization been in business as a Contractor?(required)
1.2 How many years has your organization been in business under its present business name?(required)
1.2.1 Under what other or former names has your organization operated?(required)
1.3 If your organization is a corporation, answer the following:
1.3.1 Date of incorporation:
1.3.2 State of incorporation:
1.3.3 Presidents Name:
1.3.4 Vice-President’s name(s):
1.3.5 Secretary’s name:
1.3.6 Treasurer’s name:
If your organization is a partnership, answer the following:
1.4.1 Date of organization:
1.4.2 Type of partnership (if applicable):
1.4.3 Name(s) of general partner (s):
1.5 If your organization is individually owned, answer the following:
1.5.1 Date of organization
1.5.2 Name of owner:
1.6 If the form of your organization is other than those listed above, describe it and name the principles:

2. LICENSING

2.1 List jurisdictions and trade categories in which your organization is legally qualified to do business, and indicate registration or license numbers, if applicable.
2.2 List jurisdiction in which your organization’s partnership or trade name is filed.

3. EXPERIENCE

3.1 List the categories of work that your organization normally performs with its own forces.(required)
3.2 Claims and Suits. (If the answer to any of the questions below is yes, please attach details.)
3.2.1 Has your organization ever failed to complete any work awarded to it?
Yes No
If yes, explain
3.2.2 Are there any judgements, claims, arbitration proceedings or suits pending or outstanding against your organization or its officers?
Yes No
If yes, explain
3.2.3 Has your organization filed any law suits or requested arbitration with regard to construction contracts within the last five years?
Yes No
If yes, explain
3.3 Within the last five years, has any officer or principal of your organization even been an officer or principal of another organization when it failed to complete a construction contract? (If the answer if yes, please attach details).
Yes No
If yes, explain
3.4 Please upload a file listing major construction projects your organization has in progress, giving the name of the project, owner, architect, contract amount, percent complete and scheduled completion date.
3.4.1 State total worth of work in progress and under contract:(required)
3.5 Upload a file listing the major projects your organization has completed in the past five years giving the name or project, owner, architect, contract amount, date of completion and percentage of the cost of the work performed with your own forces.
3.5.1 State average annual amount of construction work performed during the past five years:(required)
3.6 Please upload a file listing the construction experience and present commitments of the key individuals of your organization.

4. REFERENCES

4.1 Trade References:(required)
4.2 Bank References:(required)
4.3 Surety:
4.3.1 Name of bonding company:
4.3.2 Name of address of agent:

5. FINANCING

5.1 Financial Statement
5.1.1 Attach a financial statement , preferably audited, including your organization’s latest balance sheet and income statement showing the following items:
- Current Assets (e.g.; cash, joint venture accounts, accounts receivable, accrued income, deposits, materials inventory and prepaid expenses).
- Net fixed Assets:
- Other Assets:
- Current Liabilities (e.g.; accounts payable, notes payable, accrued expenses provision for income taxes, advances, accrued payroll taxes):
- Other Liabilities (e.g.; capitol, capitol stock, authorized and outstanding shares per values , earned surplus and retained earnings).
Upload financial statement
5.1.2 Name and address of firm preparing attached financial statement, and date thereof:
5.1.3 Is the attached financial statement for the identical organization named on page one?
Yes No
5.1.4 If not, explain the relationship and financial responsibility of the organization whose financial statement is provided (e.g., parent-subsidiary)
5.2 Will the organization whose financial statement is attached act as guarantor of the contract for construction?
Yes No

6. SIGNATURE

6.1 Name of Organization:(required)
By:(required)
Title:(required)
Date:(required)
This form is approved and recommended by The American Institute of Architects (AIA) and The Associated General Contractors of America (AGC) for use in evaluating the qualifications and contractors. No endorsement of the submitting party or verification of the information is made by the AIA or AGC.

Verification Code

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