Potential Subcontractor Inquiry Form

Company Name

Company Contact

First Name

Last Name

Phone

(###)

###

####

Website (If Applicable)

http://

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Areas/States That Your Company is Willing to Work

Types/Number of Crews That Your Company Has (Underground, Aerial, Splicing, Blow Crews, Etc.)

Equipment Your Company Owns to Complete Jobs (Please include how many of each)

Date Your Company is Available to Start Work

YYYY

Does Your Company Have a Contractor's License

If YES, What States Do You Have a License In

Does Your Company Have Liability Insurance Coverage

General Liability Insurance Coverage

Do You Have a Safety Program?

Briefly Describe Your Company's Safety Program