Bid Form

SUBCONTRACTOR BID LIST FORM

In an effort to better understand your company's qualifications to perform work for Ceroni Piping Co. we request that every Subcontractor and Supplier fill out this form. Please do so completely and accurately.

All information requested is label label-danger for pre-qualification purposes.

If you have questions, contact Marilyn White at 815-332-7777.

Please Check One:
Date:

Prepared By:   

Title:

1. GENERAL:

Company Name Years in Business (current name)
Address Previous/Trade Names (DBA's)
City Company President's Name
State/Province Company Contact Name
Zip/Postal Code Contact Title
Telephone Contact Email
Fax  
Website Address Federal Employer ID#
  Number of Employees Office:

Field:

2. ORGANIZATION:

Company Type   Primary Market(s) Served





 












Classification
Please check the category(s) that applies to your company.
Labor Affiliation
Please Check appropriate Box
Subcontractor Not affiliated with any union
Manufacturer's Representative Affiliated with AFL-CIO
Supplier Affiliated with other union
Manufacturer Name OTHER affiliation here
Services Materials Only / Equipment Supplier


Equal Employment Opportunity Status
Please indicate the Equal Employment Opportunity Laws category(s) under which your company qualifies.







Please list the agencies certifying you for each category and the expiration date of your certification.
If minority, please select which one:
Note: If you do qualify as one of the above, you may be required to provide a copy of your certification for each individual category. If you do not qualify, or you cannot furnish a valid certification as proof of qualification, check "Other."

3. FINANCIAL

 
 
 
The Information Above Was Provided Using:

Dun & Bradstreet Number
Current D & B Rating
Paydex Rating

Is your company or any of its owners or officers currently involved in any litigation, mediation, arbitration or prosecution or defense of formal claims in connection with any contract, project or subcontract? If Yes, please explain and provide details.
 
Has your company or any affiliated company or any of its principals ever petitioned for bankruptcy, failed in business, closed a business, defaulted or failed to complete on a contract, or been asked to post collateral against a loss? Yes   No If Yes, please explain and provide details.

4. SAFETY



Full-Time Safety Professionals on Staff?   

Has your company received an OSHA citation within the past 3 years for any reason?    If Yes, please state the number of citations and describe below.
   
   

Complete the following for the last 3 years:
Year
Interstate EMR
State EMR (if applicable)
Injuries Per Workhour
Total Hours Worked
Lost Time Accidents
DART Rate

Return to Work/Modified Duty Program
  
   
Disciplinary Program for Safety Violations   
   
Drug Testing Program   

5. INSURANCE:

Umbrella Liability  
Does Your Firm Perform Design?  
Professional Liability  
    Pollution Liability  
   

6. SUSTAINABILITY:

Participated on a LEED Certified Project    
How Many LEED Certified Projects    
Which LEED Rating System Was Utilized    
Level(s) of Project Certifications Achieved    
Did Your Firm Perform Design?    
Did Your Firm Perform Material Selection?    
Participate in a Commissioning Process    
Contact Responsible for the Data/Document Collection    
How Many LEED Accredited Professionals  
Employed By Your Firm  
 
Participated on a Project Certified By An  
Organization Other Than The USGBC/GBCI  
 
If Yes, What Rating System Was Utilized?    

7. WORK EXPERIENCE

Typical Project Size
Please select the one category that best applies to your company.

Please list the 3 largest projects completed in the last 5 years.
Project/Location  Contract Amount
$
$
$
   
Total Number of Projects Now in Progress $
Total Contract Value of Current Projects $
Current Backlog $
   
General Contractor References  
 
 
 
 
 
Please list any projects you have worked on in the last 3 years.
Project/Location  Contract Amount
$
$
$

Company's Operating Area by Telephone Area Code
In the area below, please check the area codes in which your company does business. Click the state name to display the area codes in that state.

 
 
Alabama
  ANB 205
  AUO 205
  BHM 205
  DEM 205
  DHN 205
  FLR 205
  HSV 205
  MOB 205
  MON 205
  MGM 205
  TCL 205
Alaska
     
Arizona
  FLG 602
  HOL 602
  IGM 602
  PHX 602
  PRC 602
  SAO 602
  TUS 602
  YUM 602
Arkansas
  ELD 501
  FSM 501
  HEL 501
  HOT 501
  JBR 501
  LIT 501
  MAR 501
  PIN 501
  TXK 501
  MEM 501
California
  ACV 707
  BFL 805
  BAR 619
  BLH 619
  BUR 818
  CEC 707
  FAT 209
  IPL 619
  LAX 213
  LAC 310
  NEE 619
  OAK 510
  ONT 714
  ORO 916
  LAX 818
  PAS 805
  RDD 916
  SMF 916
  SAE 714
  SAN 619
  SFO 415
  SJC 408
  SNA 714
  SBA 805
  CSN 916
  SCK 809
  SUS 916
  UKI 707
  YRE 707
Colorado
  ALS 719
  WBU 303
  BUL 719
  COS 719
  CRA 303
  DEN 303
  DRO 303
  FNL 303
  GSC 303
  GJT 303
  GXY 303
  GUC 303
  LAA 719
  LEA 303
  MTJ 303
  PUB 719
  SBS 303
  STC 303
  TRN 719
Connecticut
  BDL 203
  BDR 203
  HVN 203
  GON 203
  STA 203
  WAT 203
Delaware
  DOV 302
  GEO 302
  ILG 302
District of Columbia
  WAS 202
Florida
  BOC 407
  FLL 305
  FMY 813
  FPR 407
  GNV 904
  JAX 904
  EYW 305
  LKL 813
  LKE 407
  LKW 813
  MBL 407
  MIA 305
  APF 813
  OCF 904
  ORL 407
  PFN 904
  PNS 904
  SRQ 813
  TLH 904
  PIE 813
  PBI 407
Georgia
  ABY 912
  AHN 706
  ATL 404
  AGS 706
  CSG 912
  CHA 706
  DUB 912
  MCN 912
  SAV 912
  VLD 912
  WAY 912
Hawaii
  HNL 808
  HNM 808
  ITO 808
  OGG 808
  MUE 808
  MKK 808
  KOA 808
  LNY 808
  LIH 808
Idaho
  BOI 208
  COE 208
  IDA 208
  LWS 208
  SAL 208
  TWF 208
Illinois
  CMI 217
  CHI 708
  EFF 217
  GCI 618
  KAN 815
  MWA 618
  MLI 309
  PIA 309
  UIN 217
  RFD 815
  SPI 217
  CHI 312
Indiana
  COL 812
  EVV 812
  FWA 219
  GYY 219
  IND 317
  LAF 317
  MAD 812
  MIE 317
  PER 317
  Rih 317
  SBN 219
  HUF 812
  VIN 812
Iowa
  AME 515
  BRL 319
  CID 319
  OMA 712
  MLI 319
  DSM 515
  DBQ 319
  FOD 515
  MHN 515
  MCW 515
  OTM 515
  SUX 712
  SPW 712
  ALO 319
Kansas
  CHU 316
  COB 913
  DDC 316
  GBD 316
  HUT 316
  LBL 316
  MRS 913
  PRT 316
  SLN 913
  SCT 316
  STK 913
  TOP 913
  ICT 316
Kentucky
  ASH 606
  BGN 502
  CVG 606
  LEX 606
  SDF 502
  MDO 606
  OWB 502
  PAH 502
  PRE 606
  SOM 606
Louisiana
  ESF 318
  BRT 504
  LCH 318
  MLU 318
  NTO 318
  MSY 507
  SHV 318
Maine
  BGR 207
  CAU 207
  HUL 207
  LEW 207
  MIL 207
  PWM 207
Maryland
  ANN 301
  BWI 410
  WAS 301
  CBE 301
  HAB 301
  LXP 301
  SBY 410
Massachusetts
  BOS 617
  EWB 508
  PSD 413
  SPM 413
  ORH 508
Michigan
  APN 989
  BTL 269
  CAD 231
  CHE 616
  DTT 313
  FNT 810
  GRR 616
  IMT 906
  AZO 269
  LAN 517
  MQT 906
  MKG 231
  PHM 810
  MSB 989
  SSM 906
  TVC 231
Minnesota
  BJI 218
  BEM 612
  BRD 218
  GFK 218
  DLH 218
  HIB 218
  INL 218
  MKT 507
  MSP 612
  FAR 218
  RST 507
  SLD 612
Mississippi
  HEL 601
  GTR 601
  GLH 601
  GPT 601
  HAT 601
  JAN 601
  MCC 601
  MEI 601
  HEZ 601
  MEM 601
  TUP 601
  WIN 601
Missouri
  CGI 314
  CHL 816
  COU 314
  FAM 314
  HAN 314
  JLN 417
  MKC 816
  IRK 816
  AIZ 314
  NEA 417
  PBF 314
  ROL 314
  SJM 816
  STL 314
  SED 816
  SGF 417
  WPM 417
Montana
  BIL 406
  BZN 406
  BTM 406
  CUT 406
  GLA 406
  GTF 406
  HRV 406
  HLN 406
  FCA 406
  LWT 406
  LIV 406
  MLS 406
  MSO 406
  SDY 406
Nebraska
  AIA 308
  ATN 402
  BUW 308
  CDR 308
  GRI 308
  HIS 402
  LNN 308
  LNK 402
  MCK 308
  OFK 402
  LBF 308
  OMA 402
  BFF 308
  SNY 308
  SUX 402
  VAN 402
Nevada
  AUT 702
  CAL 702
  CSN 702
  IKO 702
  ELY 702
  HAW 702
  LAS 702
  RNO 702
  TON 702
  WIM 702
New Hampshire
  BER 603
  CLA 603
  CON 603
  LCI 603
  MHT 603
  NAH 603
  POR 603
  ROR 603
New Jersey
  AIY 609
  CAM 609
  CLI 201
  LAE 908
  EWR 201
  NEW 908
  PAT 201
  PHI 908
  TTN 609
  VNE 609
New Mexico
  ALM 505
  ABQ 505
  CNM 505
  FMN 505
  GUO 505
  LRU 505
  LAV 505
  PAL 505
  RAT 505
  ROW 505
  SAF 505
New York
  ALB 518
  BGM 607
  BUF 716
  ELM 607
  JHW 716
  NYC
  ONH 607
  POU 914
  ROC 716
  SYR 315
  UCA 315
  ART 315
North Carolina
  AVL 704
  CLT 704
  ETH 919
  FAY 919
  GSO 919
  OAJ 919
  RDU 919
  ILM 919
  GSO 919
North Dakota
  BIS 701
  DVL 701
  DIK 701
  FAR 701
  GFK 701
  JMS 701
  MOT 701
  GSO 701
Ohio
  CAK 216
  COT 614
  CVG 513
  CLE 216
  CMH 614
  DAY 513
  DEF 419
  LIA 419
  MFD 419
  MET 614
  PSM 614
  SIN 513
  SIL 614
  TOL 419
  YNG 216
  ZES 614
Oklahoma
  ARE 405
  ELK 405
  WDG 405
  FTS 405
  GUY 405
  LAW 405
  MLC 918
  OKC 405
  TUL 918
  WIT 405
Oregon
  BEN 503
  EUG 503
  LIE 503
  MFR 503
  ONA 503
  PDT 503
  PDX 503
  503 0
  THE 503
Pennsylvania
  ABE 215
  ERI 814
  MDT 717
  JST 814
  PHL 215
  PIT 412
  AVP 717
  IPT 717
Rhode Island
  CAT 401
  MIT 401
  NOT 401
  PVD 401
  WAR 401
  WST 401
  WON 401
South Carolina
  AND 803
  CHS 803
  CAE 803
  FLO 803
  GSP 803
  MYR 803
  ONE 803
  SAR 803
South Dakota
  ABR 605
  HOP 605
  HON 605
  MOE 605
  PIR 605
  RAP 605
  FSD 605
  ATY 605
Tennessee
  CHA 615
  CKV 615
  MKL 901
  JON 615
  TYS 615
  MEM 901
  MUR 615
  BNA 615
Texas
  ABI 915
  AMA 806
  AUS 512
  BPT 409
  BRO 512
  BAN 409
  CES 817
  CRP 512
  DFW 214
  FTW 817
  ELP 915
  GLS 409
  HOU 713
  LRD 512
  GGG 214
  LBB 806
  LUF 409
  MAF 915
  PEO 915
  SJT 915
  SAT 512
  SHE 214
  SON 915
  TPL 817
  TXK 214
  TXR 214
  UVA 512
  VCT 512
  ACT 817
  SPS 817
Utah
  BAM 801
  CDC 801
  CNY 801
  OGD 801
  PUC 801
  PRO 801
  RID 801
  SLC 801
Vermont
  BEV 802
  BAT 802
  BTV 802
  NOR 802
  RUT 802
Virginia
  WAS 703
  TRI 703
  CHO 804
  DAN 804
  FRO 703
  PHF 804
  ORF 804
  RIC 804
  ROA 703
Washington
  AER 206
  BLI 206
  GAN 509
  LON 206
  MWH 509
  CLM 206
  PUW 509
  RAN 509
  SEA 206
  GEG 509
  ALW 509
  EAT 509
  YKM 509
West Virginia
  BLD 304
  CRW 304
  EKN 304
  HTS 304
  MGW 304
  PKB 304
  WHE 304
Wisconsin
  ATW 414
  EAU 715
  FOM 414
  GRB 414
  LSE 608
  MSN 608
  MTW 414
  MKE 414
  OSH 414
  DLH 715
  AUW 715
Wyoming
  CPR 307
  CYS 307
  COD 307
  GCC 307
  JAC 307
  LAR 307
  NAR 307
  PNE 307
  RWL 307
  RIW 307
  RKS 307
  SHR 307
    
 
 
 
 
 
 
 
 
 
 
 
 
 
Other locations:

Bid Item Categories
From the list below, please check all the categories your company normally bids. The bid items are coded according to the Construction Specifications Format Uniform System. Click the division title to display the bid categories in that division.

 
General Requirements
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sitework
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Concrete
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Masonry
 
 
 
 
 
 
 
 
 
 
Metals
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Wood & Plastic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ther & Moisture Prot
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Doors & Windows
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Finishes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Specialties
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Equipment
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Furnishings
 
 
 
 
 
 
 
 
 
 
 
Special Contruction
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Conveying Systems
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mechanical
 
 
 
 
 
 
 
 
 
Electrical
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Systems
 
 

Authorized Officer verifying the truthfulness of the above information      Title  

Mail to:
Marked confidential to the attention of:
Marilyn White, Administrator
Ceroni Piping Co.
7770 Ceroni Rd.
Cherry Valley, IL 61016

Fax to:
1-815-332-7775
Attention: Marilyn White

The Subcontractor, by submission of the information above, agrees to the applicable Subcontract Agreement "Terms and Conditions" including Exhibits B and C. These agreements can be found by accessingwww.ceronipiping.com, our website.

We trust that you will view this effort not as an invasion of your company’s privacy, but as an effort to make sure that we have assembled a network of highly qualified subcontractors to participate in our projects. We know that you, like Ceroni Piping Co., would prefer to compete and work alongside other subcontractors who are financially strong and qualified to perform.

Federal Communications Commission (FCC) regulations require us to document your permission to receive facsimiles (faxes) and emails. In order to ensure you continue to receive timely bid information, by submission of this Bid List Form you consent to receive faxes and emails that contain Bid Invitations, Notifications, and other communications sent by or on behalf of Ceroni Piping Co. and its affiliates. This consent will remain in effect until such time as Ceroni Piping Co. receives written notification canceling this agreement.