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*Submitted By Name:
*Submitted By Title:
Contact Person's Name
(if different from above):
Contact Person's Title
(if different from above):
Company Name:
Select one of the following:
Address:
Telephone:
Type:
Telephone:
Type:
Telephone:
Type:
Fax:
*Email Address:
Website Address:
1. Please check all categories of work that a representative of your organization
performs, using it's own resources:
General Construction
HVAC
Plumbing
Electrical
Landscaping
Paving/Asphalt
Painting
Janitorial
Roofing
Other
2. List trade categories in which your organization is legally qualified to do business:
3. How many years has your organization been in business under its present name?
4. How many permanent employees do you presently have on payroll?
5. Have there ever been or are there any judgments, claims, liens, arbitration proceedings or suits pending or outstanding against your organization or its officers?
Yes No
If yes, please list a brief explanation.
6. Has your organization ever failed to complete any work awarded to it?
Yes No
If yes, please list a brief explanation.
7. If your organization has a Performance Bond, list the number here:
8. Is your company a current member of the Charleston Metro Chamber of Commerce?
Yes No
9. Job references - Please list your last three:
Contact Person: Phone:
Contact Person: Phone:
Contact Person: Phone:
10. Trade references - Please list three
Name of Company: Contact Person: Phone:
Name of Company: Contact Person: Phone:
Name of Company: Contact Person: Phone:
11. Bank reference
Contact Person: Phone:

Terms and Conditions:
1. I, the person listed above as the submitter, certify that the information provided herein to The Beach Company is true and sufficiently complete so as not to be misleading.
2. I will mail or have my insurance company mail a copy of my organization's Certificate of Insurance to The Beach Company, Attn: Property Management, ensuring that the agent's name and coverage for Workman's Compensation are shown.
3. This qualification statement does not form any relationship between The Beach Company, its affiliates, heirs or assigns and your company, or require The Beach Company to hire your company. This statement will be reviewed by Property Management and you will be contacted if we are interested in a proposal from your company.

I understand and accept the terms and conditions of the disclaimers above.