Subcontractor Submission Form
Lanier Building
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Email *
Name of Company *
Mailing Address *
Phone Number *
Contact Name *
Description of subcontract work performed or products sold *
At the listed address, the company operates as:  *
If Corporation, is qualified to do business in:
If Affiliate, Affiliate of:
Affiliate HQ located:
Branch Office of Company HQ located
If a Supplier, what is the company's relationship with manufacturers? 
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How many years has your Company been in business as a subcontractor/supplier under the present business name?
Union Affiliation of Company *
Your organization's current EMR
Name of Insurance Company
Insurance Company Address
Insurance Company Phone
List 3 Contractor References  *
Are there now any liens, suits, or judgments pending or outstanding, and unsatisfied as a result of the business operations of the Company, its officers, or its predecessors? *
The Pre-qualification Statement is submitted by the applicant with the full knowledge that the contents contained herein are to be considered as a true and accurate representation of the capabilities and financial capacity of the Company to perform work on the above subject project. Should the information submitted be incomplete, Lanier Building, Inc. may not be able to consider the Company for the subject project qualified bidder's listing.
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Firm *
Signed *
Date *
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