Orange County NC Website
Browse       Search
Gilbane Building Company 7 <br /> Prequalification Form for First-Tier Subcontractors under CM at Risk <br /> Orange County Crisis Diversion Facility <br /> SECTION 1. GENERAL COMPANY INFORMATION <br /> 1.1. Office Location <br /> Legal Company Name: <br /> Physical Address: <br /> Mailing Address: <br /> City/State/Zip: <br /> Federal Tax ID#: <br /> Website Address: <br /> Phone: Fax: <br /> Primary Contact: Email address: <br /> (Contact person for Prequalification Committee.) <br /> Bidding Contact: Email address: <br /> (Person to receive bid documents, addenda, clarifications and other bid notices.) <br /> Must attached a copy of your current (2022) W-9 =W-9 Attached <br /> Owners/Officers/Partners (Individuals who are authorized to represent or conduct business for and sign legal <br /> documents for the firm) <br /> Full Legal Name: <br /> Title: <br /> Phone: <br /> Email: <br /> Year company founded or number of years in business: <br /> 1.2. Business Type <br /> Business Type (check box) <br /> =Corporation =Partnership =LLC =Sole Proprietor I=Joint Venture <br /> HUB Certification - Indicate your NC Statewide Uniform Certification: (check box) <br /> =Black =Hispanic =Asian-American (=American Indian (=Female =None <br /> =Socially and Economically Disadvantage =Disabled-Owned =Disabled Business Enterprise <br /> See website link for more information: http://www.doa.nc.gov/hub/swuc-htm <br /> Is your firm registered with the State of North Carolina to do business? =Yes =No <br /> Is your firm owned or controlled by a parent or any other organization? =Yes =No <br /> If yes, describe Ownership (include Parent Company Name, Federal Tax ID#,full address): <br /> List all other names your firm has operated as for the past (S)years: <br /> Page 3 12 <br />