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Welcome to Tectonic's new website!

If you are looking for access to your email, timesheet / expense report, and other services, please click on the icon found on the bottom left of the screen.

Become a prequalified vendor

INSTRUCTIONS

Companies interested in providing professional services or construction services to Tectonic must be prequalified. Firms that provide products or other services are not required to be prequalified.

Thank you for your interest in doing business with Tectonic:
Please answer all questions and provide all requested information. If a question is not applicable, indicate as “N/A” and provide an explanation if necessary.
Supplemental information sheets should be used to provide additional information that does not fit on the form.
Clearly indicate at the top of the supplemental information sheet which section of the questionnaire it references.
After the questionnaire is fully reviewed for completeness, please click on the “Submit” button.
Any questions regarding this form can be sent to prequal@tectonicengineering.com.

PRIMARY (CORPORATE) OFFICE INFORMATION

Address

City

State

Zip

Phone No.

Fax No.

Formation Date *

(Use this format: mm-dd-yyyy)

State of Formation *

DBA or Trade Name

Website

Tax ID (EIN) *

Dun & Bradstreet #

NAICS Code

PRIMARY CONTACT

Primary's Name *

Primary's Title *

Email *

Phone Number *

SECONDARY CONTACT

Secondary's Name

Secondary's Title

Phone Number

CLAIMS CONTACT

Claim Contact Name

Claim Contact Title

Phone Number

OFFICERS

Name

Title

Add Remove

STOCKHOLDERS

(include only those owning 5% of more of stock. Attach a supplemental sheet if needed.)

Name

% Stock Ownership

Add Remove

COLLECTIVE BARGAINING AGREEMENTS

(Identify union affiliations)

Name

Add Remove

Do you have experience with projects that require Certified Payroll and Davis Bacon Wage Rates?

Yes

SERVICE CAPABILITIES

State *

License Number

Add Remove

STAFFING

Professional (Licensed)

Technical (Non-professional)

Administrative

Total Staffing

OFFICE LOCATIONS & REGIONS SERVED

(Including primary office)

Location *

Staff *

Services Provided *

Lookup

Add Remove

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LITIGATION / CONTRACT DISPUTES

List any judments, arbitrations, liens, insurance claims, or lawsuits the firm has been subject to within the past 5 years. If there are none, respond by saying there were none.

Please enter all judgements, arbitrations, liens, insurance claims, and/or lawsuit descriptions: *

Has firm at any time failed to complete a contract or had a contract terminated? *

Yes

If yes, please explain: *

File Upload

Maximum file size: 5MB

CRIMINAL BACKGROUND INFORMATION

Has the firm, any affiliate, or any of the current or former principal owners, stockholders, or officers or managerial employees:

been convicted of a misdemeanor and/or found in violation of any administrative, statutory, or regulatory provisions in the past five (5) years? *

Yes

been convicted of a felony, and/or crime related to truthfulness and/or business conduct in the past ten (10) years? *

Yes

have any felony, misdemeanor and/or administrative charges currently pending? *

Yes

If you answered "Yes" to any of the above questions, please provide an explanation:

Insurance Coverage

State your standard coverage limits in COLUMN 2 below.

POLICY

Occurrence (or claim) limit

Aggregate limit

GCL

GCL Occurrence Limit

GCL Aggregate Limit

Auto

Auto Occurrence Limit

Auto Aggregate Limit

Umbrella / Excess

Umbrella / Excess Occurrence Limit

Umbrella / Excess Aggregate Limit

Pollution / Liability

Pollution Liability Occurrence Limit

Pollution Liability Aggregate Limit

Workers Compensation

Workers Compensation Occurrence Limit

Workers Compensation Aggregate Limit

Professional Liability

Professional Liability Occurrence Limit

Professional Liability Aggregate Limit

Cyber / Network Security Liability

Cyber / Network Liability Occurrence Limit

Cyber / Network Liability Aggregate Limit

If a contract requires additional insurance limits, would you be willing to consider purchasing additional insurance coverage? *

Yes

Health & Safety (Cont.)

Provide the following information for the last 3 years. You must respond to all questions even if your firm is not required to maintain OSHA logs.

YEAR (most recent 3 years)

Current Year

Prior Year

Worker's Compensation
Experience Modification Rate (EMR)

Worker's Compensation Experience Modification Rate (EMR) (Current Year) *

Worker's Compensation Experience Modification Rate (EMR) (Prior Year)

Number of Fatalities
(list any, explain in Supplemental Information field at the end of this form.)

Number of Fatalities (Current Year)

Number of Fatalities (Prior Year)

Lost Work Day Incident Rate
(total lost-time recordable cases x 200,000 / total hours worked.)

Lost Work Day Incident Rate (Current Year) *

Lost Work Day Incident Rate (Prior Year) *

OSHA Recordable Incident Rate
(total OSHA recordable cases x 200,000 / total hours worked)

OSHA Recordable Incident Rate (Current Year)

OSHA Recordable Incident Rate (Prior Year)

Total Number of Hours Worked
(per occurrence)

Total Number of Hours Worked (Current Year)

Total Number of Hours Worked (Prior Year)

The following upload fields allow for uploading of multiple files.

To upload multiple files please click-and-hold the CTRL key and left-click with your mouse.
Once you have selected the file(s) hit the "Open" button on the the dialog box.

Attach copies of your OSHA 300 & 300A logs for the last 3 years (Not required).

Maximum file size: 10MB

If you are human, leave this field blank.

Service Evaluation

Section

Contact Name: *

Your name

Company Name: *

The company you're working with

Phone Number: *

A contact phone number if you would like to be contacted (In this format XXX-XXX-XXXX)

Did you receive your report(s) in a timely manner? *

Yes

Were you pleased with the customer service you received? *

Yes

Did you have sufficient information? *

Yes

Did you receive your final report in a timely manner? *

Yes

Please let us know how we can improve our service. *

Feel free to express your views of TECTONIC service.

Please verify your input by checking the box below.

If you are human, leave this field blank.

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Tectonic Web Services

Welcome to Tectonic's new website!

Become a prequalified vendor

INSTRUCTIONS

GENERAL

PRIMARY (CORPORATE) OFFICE INFORMATION

PRIMARY CONTACT

SECONDARY CONTACT

CLAIMS CONTACT

OFFICERS

STOCKHOLDERS

COLLECTIVE BARGAINING AGREEMENTS

SERVICE CAPABILITIES

SERVICES PROVIDED

STAFFING

OFFICE LOCATIONS & REGIONS SERVED

LITIGATION / CONTRACT DISPUTES

CRIMINAL BACKGROUND INFORMATION

Insurance Coverage

Health & Safety

Health & Safety (Cont.)

Health & Safety (Cont.)

Health & Safety (Cont.)

The following upload fields allow for uploading of multiple files.

Special Inspection Feedback Form

Section

Section

Section

Service Evaluation

Section

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