Pre-Qualification Form Instructions (Material/Equip

Material Equipment / Misc Services PQ Walbridge Pre-Qualification Form Instructions

All information as submitted will be stored in our Corporate Data Base to be accessed by all Divisions and Departments of Walbridge. If you have additional locations that we don’t know about or if the information is not current or accurate, then your company could be denied participation in our Bid process and/or issuance of a Contract.

If you have any questions regarding informational requirements or are having technical problems please call 313 963- 8000 and ask for Pre-Qualification Administrator

In order to start the prequalification registration process we will need your companies: 1. EIN – Employer Identification Number 2. Legal Company Name

To Complete Section: “Company Information” you will need the following information:

1. Company Legal Name, Address, Phone Number, Website (if applicable), and a Contact Name, Phone Number and Email Address (if applicable) 2. Remit Address (where we would send mail) if it is different than above 3. Additional Locations w/ same Federal Tax ID: If you have additional locations that we need to know about because of territorial boundaries or service/product coverage, please list each location with address, phone number and point of contact. 4. The type of business that your company established: Corporation, Partnership, Sole Proprietor, LLC or a Joint Venture. a. If you have a Partnership, we will need to know the type of Partnership - General, Limited or Association. If Joint Venture, we will need the name of your Joint partner. b. If your company is a Subsidiary, a business that is controlled by a larger business, please list the Parent Company Name. 5. The numbers of years under present Ownership and the year your Business was established.

To Complete Section: “Type of Service provided” you will need the following information:

1. Check the appropriate category or categories that best describes the type of service(s) your company provides. 2. Provide a Brief Description of the Type of Service either performed or provided by your company. 3. Tell us the number of company employees, and if they are Union, Non-Union or Both.

To Complete Section: “Areas of Work” you will need to:

1. Mark the appropriate States or Provinces in which you will provide service in. 2. If you selected USA, and your company will work in all areas of the United States please select either “ALL of Continental U.S.” or “All of U.S.”, otherwise select each individual state and regional area(s) where your company will provide service. 3. If you selected Canada, and your company will work in all areas of the country please select either “ALL otherwise select each individual province and regional areas where your company will provide service.

To Complete Section: “Sales History” you will need to know the following:

1. Average Sales volume for the past three years. 2. If your company has ever failed to complete any services as contracted to your company. If yes, you will need to list the reason. 3. List Three Business References from past projects. Please list the company name, Project Location (City and Stat) Contact and Phone Number.

1 of 13 2011 COMBO – M/E, MISC PQ

To Complete Section: “Registered / Certified Business” you will need to know the following:

1. If your company has been classified as a Registered / Certified Business from any of these agencies or in any of these categories (Federal, County, City, Minority, Woman Owned, Small Business or Disadvantaged Business). If you are certified, please fill out this section in its entirety. Remember, we must receive a valid copy of your Certifications in order to be listed as Certified.

Note! By having an Employer Identification Number, does not qualify you as a certified business. That simply means you are a registered business.

To Complete Section: “Quality, Design & System Software” you will need to know the following:

1. If you have a “Certified” Quality Management system. If so, list the agency name and date your company was certified. If you do not have a certified system then you will need to know if you are planning on becoming certified and if you have some type of quality process that is in place today. 2. If you have Design Software. If so, the type and the number of software seats. If you utilize 3D and how many employees that are trained to use it. Has your company been part of a project implementing 3D and does your model import directly into fabrication equipment. 3. If you have any unique or proprietary System(s) Software that makes your business or service, better then your competitor; please let us know about it.

To Complete Section: “Insurance” you will need to know the following:

1. We want to know if your insurance policies meet or exceed our stated limits. If they do not, then we may require additional insurance coverage depending on our contractual obligations and the type of service being performed or provided.

To Complete Section “Application Completed By” you will be required:

1. To print the Name, Title, Phone number and Email address of the individual who is responsible for filling out the questionnaire. 2. In order to forward the application to the proper approving authority, we need the Project name or the name of our Company Division with Contact name. If you are “Pre-Qualifying for Future Business” please mark the appropriate box. 3. Sign and date application and either fax to (313) 234-0947 or e-mail to [email protected]

Walbridge Pre-Qualification Form Material / Equipment – Miscellaneous Services

Walbridge respects and welcomes diversity in its directors, employees, customers, suppliers and others. Walbridge is committed to equal employment opportunity (EEO) without regard to race, color, religion, sex, age, physical impairment, national origin, height, weight, marital status, veteran status or any other characteristic protected by law. Because of this commitment to EEO, Walbridge expects its Vendors/Contractors to adhere to this same policy. Failure to do so may result in being removed from our Vendor list.

You must have an Employer Identification Number (EIN) also known as Federal Tax Identification Number to continue. This is a nine digit number that is issued from the Federal Government. Please enter your E.I.N. number below.

E.I.N / B.N. #

Company Name

This Form will not be accepted or processed unless it is completed in its entirety.

Company Information Corporate/Business Address:

Legal Company Name

Street/P.O. Box: City:

State: Postal Code: Telephone: Fax:

Website: Main Administrative Contact Name: Title: Main Administrative Contact Email: Phone: Is your Remit Address different from above? Yes No If Yes, fill in shaded area. If no, continue to next question.

Street/P.O. Box:

State/Province: Postal Code:

Do you have additional locations (that you want us to know about), that have the same Federal Tax I.D. that you are pre-qualifying with? Yes No If Yes, fill in shaded area. If no, continue to Business Type *Note If you have more than one additional location please list on separate sheet and attach.*

Location Name: Address:

City: State: Postal Code:

Contact: Phone:

Email: Business Type: Corporation Partnership Sole Proprietor

LLC Joint Venture If Partnership is checked General Limited Association

If Joint Venture is checked Please list the Name(s) of all Joint Venture Partner(s) below:

Number of years under present Ownership: Year Business was established:

Is your company a Subsidiary? Yes No If Yes, fill in shaded area below: List Parent Company Name:

Type of Service Provided:

Consulting Distributor, Equipment &/or Tool Crating/Packaging Supplier Environmental Surveying/Testing Electrical Manufacturing Housekeeping (service) Hydraulic ReSteel Fabricator Parking Lot Maintenance Mechanical Steel Fabricator Plant Maintenance/Operation Pneumatic Other (please explain on line below) Rental Equipment Other (please explain on line below) Security (service) Shredding (service) Snow removal (service) Material Supplier Testing/Inspection (service) Concrete Transportation Lumber Uniforms (service) Steel Waste Mgmt. (service) Other (please explain on line below)

Please provide a brief description of the type of Service/Product performed or provided below. Brief description:

Total Number of Employees # Union Non-Union Both

Areas of Work If your firm will work, service, or ship to all of the United States or Canada please select one.

All of Continental US All of US (incl. Alaska, Hawaii All of Canada Otherwise, select the individual States or Provinces below. By Individual States and Canadian Provinces Alaska Georgia Louisiana Licensed Atlanta Metro New Orleans Metro Alabama Northern Northern Birmingham Metro Central Southern Northern Southern All Central All Licensed Southern Licensed Maine All Hawaii Licensed Licensed Licensed Maryland Arizona Idaho Washington D.C. Metro Phoenix Metro Northern Eastern Tucson Metro Southern Western Northern All All Central Licensed Licensed Southern Illinois Massachusetts All Chicago Metro Boston Metro Licensed Northern Eastern Arkansas Central Western Licensed Southern All California All Licensed Sacramento/San Fran Area Licensed Michigan L.A./San Diego Area Indiana Detroit Metro Northern Indianapolis Metro Southeastern Central Northern Southwestern Southern Central Northern All Southern U.P. Licensed All All Colorado Licensed Licensed Northeast Iowa Minnesota Southeast Eastern Minneapolis/St. Paul Western Central Northern All Western Southern Licensed All All Connecticut Licensed Licensed Licensed Kansas Mississippi Delaware Kansas City Metro Northern Licensed Northeastern Central Florida Southeastern Southern Northern Western All Central All Licensed Southern Licensed All Kentucky Licensed Northern Southern All Licensed

Individual States (continued)

Missouri North Carolina South Dakota Kansas City Metro Raleigh/Durham Area Licensed St. Louis Metro Greensboro/W. Salem Tennessee Northern Charlotte Metro Knoxville Area Central Northeast Nashville Metro Southern Northwest Memphis Metro All Southern Eastern Licensed All Western Montana Licensed All Eastern North Dakota Licensed Western Licensed Texas All Ohio Houston Metro Licensed Cleveland/Akron Area Austin/San Antonio Area Nebraska Columbus Area Dallas Metro Eastern Cincinnati/Dayton Area Amarillo/Lubbock Area Western Northeast El Paso Area All Northwest Northeast Licensed Southeast Northwest Nevada Southwest Southeast Las Vegas Metro All All Reno Metro Licensed Licensed Northern Oklahoma Utah Southern Oklahoma City/Tulsa Area Salt Lake City Metro All All All Licensed Licensed Licensed New Hampshire Oregon Vermont Licensed Portland Metro Northern New Jersey Eastern Southern Newark Metro Central All Trenton Metro Western Licensed Atlantic City Metro All Virginia Northern Licensed Arlington Metro Southern Pennsylvania Norfolk Area All Philadelphia Metro Northeast Licensed Pittsburgh Metro Southeast New Mexico Northeast Western Albuquerque Metro Northwest All Northern Southeast Licensed Southern Southwest Washington All All Seattle Metro Licensed Licensed Spokane Metro New York Rhode Island Eastern NYC/Long Island Licensed Central Northeast South Carolina Western Northwest Charleston Area All Southeast Columbia Metro Licensed All Greenville/Spartanburg Licensed Eastern Western All

Individual States (continued) West Virginia Wisconsin Wyoming Charleston Metro Milwaukee/Madison Area Licensed Eastern Green Bay Metro Western Northern All Southeastern Licensed Southwestern All Licensed

Canadian Provinces Alberta Newfoundland Prince Edward Island Calgary St. John’s Charlottetown Edmonton All All All Licensed Licensed Licensed Northwest Territories Quebec British Columbia Yellowknife Montreal Vancouver All Quebec City Victoria Licensed All All Nova Scotia Licensed Licensed Halifax Saskatchewan Manitoba All Regina Winnipeg Licensed Saskatoon All Nunavut All Licensed Licensed Licensed New Brunswick Ontario Yukon Territory Fredericton Toronto Licensed St. John Windsor All All Licensed Licensed

Sales History: 3 Average Annual Receipts- Please check the appropriate box below based on the following definition: Receipts means “total income” (or in the case of a sole proprietorship, “gross income”) plus “cost of goods sold” as these terms are defined and reported on Internal Revenue Service tax return forms. Receipts are averaged over a concern's latest three (3) completed fiscal years to determine its average annual receipts. If a concern has not been in business for three (3) years, the average weekly revenue for the number of weeks the concern has been in business is multiplied by 52 to determine its average annual receipts. Avg. 3 yr. Annual Receipts $4.5 Mil or less $ 4.5 Mil + - $7.0 Mil. $7Mil + - $12 Mil

$12 Mil + - $14 Mil $14Mil + - $33.5 Mil Over $33.5 Mil Have you failed to complete any Services as Contracted to your Company? Yes No If Yes, fill in shaded area. If No, continue to Top 3 Customers. Describe the Service, Customer, Location and Circumstances:

Registered / Certified Business: Is your company Registered or Certified from any Federal, City or County agencies? Yes No (i.e. Minority, Woman Owned, Small Business, Disadvantaged Business, HubZone) If yes, please answer the following questions below. If no, continue on to next page. Is your Company Minority Certified? Yes No If yes, fill in shaded area. If no, continue to next question. NMSDC (National Minority Supplier Development City (Please List) Other (Please list) Council) (Please list state) Is your Company Registered / Certified as Woman Owned Business? Yes No If yes, fill in shaded area. If no, continue to next question. WBENC (Women's Business Enterprise National Council) City (Please list) Other (Please list) Federal Which Council? Please list.

Is your Company Registered / Certified with the Federal Government? Yes No (excluding Women Owned)? If yes, fill in shaded area below. If no, continue to next question. SDB (Small Disadvantaged VOSB (Veteran Owned SDVOSB (Service Disabled HZB (HUB Zone Small Business) Business) Business ReferencesVOSB) Business) Self Certified Small Business 8 (a) CERT (Certified Other (please list) Please list three (SB) Business) Is your Company County Registered / Certified (excludingLocation: Women Owned or Yes No Company Name: Minority)? City & State only Contact: Phone: 1 If yes, fill in shaded area below. If no, continue to next question. Which U.S. State does your County certification come from? 2 Which County were you certified in: SBA (Small Business Administration) DBE (Disadvantage Business enterprise) Choose certifying agency below MDOT(Michigan Department of DDOT (Detroit Department of SMART(Suburban Mobility Authority for Regional Transportation) Transportation) Transportation ) WCC (Wayne County Certified) Other please list: Is your Company City Registered / Certified (excluding Women Owned or Minority)? Yes No If yes, fill in shaded area below. If no, continue to next question. Which U.S. State does your city certification come from? Which City does your certification come from? Please check all that applies below: (City Based Business) (City Headquartered Business) (City Small Business Enterprise) Other (please list) Other Registrations / Certifications If checked, fill in shaded area below.

Please list any other Registered or Certified Business Certifications not listed above:

Note! Your company will not be listed as a Registered or Certified Business until validated by our Corporate Headquarters. Please fax validation to (313) 234-0485. If you have any questions please call (313) 442-1272

Quality: Do you have a Registered Quality Management System? Yes No If yes, fill in shaded area below and continue to Design Software. If no, then continue to Design Software. Which agency guidelines do you operate under? Agency Name Date Certified (e.g. ISO 9001) Do you plan on becoming registered in the near future? Yes No If yes please list Date: Do you currently have some type of quality process in place? Yes No If yes, fill in shaded area below: Does it include written procedures? Yes No If yes, fill in shaded area below: Do you audit to these procedures? Yes No

Design Software: Do you have Design Software? Yes No If yes, fill in shaded area below. If no, continue to System Software: What system software do you have? And the number of seats? (Please list) Software Type # of seats Software Type # of seats Software Type # of seats

Do you utilize 3D software? Yes No If yes, fill in shaded area below: How many staff members are trained to use 3D? Have you been part of a project implementing 3D for a collision free project? Yes No Does your Model import directly into fabrication equipment? Yes No System Software: Does your company have any unique System(s) Software that we should know about? Yes No

If Yes, fill in shaded area below: Please describe:

Insurance As a General Rule, we require our Subcontractor/Vendor to have the following insurance coverage with the minimum limits as indicated below. General Liability Min. Limits Min. Limits Min. Limits Min. Limits

Personal & Products & Completed Each Occurrence Advertising. Injury Aggregate General Aggregate Bodily Injury & Property Damage $1,000,000 $1,000,000 $2,000,000 $2,000,000 Excess/Umbrella Liability $3,000,000 Automobile Liability: (Covering all owned, non-owned, & hired vehicles) $2,000,000 Combined Single Limit

Workers Compensation Min Limits

Each Accident $500,000

Disease Policy Limit $500,000

Disease Each Employee $500,000

Does your current policy meet or exceed these stated minimum limits? Yes No If No, please list current coverage below; If yes, please go to next section; Bonding:

General Liability Min. Limits Min. Limits Min. Limits Min. Limits Personal & Products & Advertising. Completed Each Occurrence Injury Aggregate General Aggregate Bodily Injury & Property Damage $ $ $ $ Excess/Umbrella Liability $ Automobile Liability: (Covering all owned, non-owned, & hired vehicles) $ Depending on contractual obligations and the type of service being performed, additional insurance maybe required. Application Completed By:

Name: Title: Phone: Email: Additional Comments:

In order to better process this Application, please state the Project Name or the Walbridge Division with Contact. If Pre-Qualifying for "Future Business" please check appropriate box. Project or Division & Contact Name: PreQual for future Business Note! By submitting this application, I certify that all information provided is true and complete so as not to be misleading!

Signature: