Healthcare

As patient demand increases, the performance requirements for centers of care rise as well. We understand how to maximize the return on your existing investment, plan for managed growth, and remain flexible to fill future needs. Tectonic has provided services to a variety of facilities in the industry including hospitals, offices, long-term care, and outpatient.

PROJECTS

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Select a Prequalification form...

The information helps Tectonic evaluate a vendor’s service capabilities, the volume of work the vendor can readily handle, insurance coverages, as well as health and safety information.

Prequalified vendors will have their purchase orders expedited and will be recommended for future work that falls within that firm’s service capabilities.

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Become a prequalified vendor

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.

GENERAL

Maximum file size: 134.22MB

Upload a copy of your certificate(s) and/or screenshot(s) verifying the above reported status. * If you do not have any verifications, please be sure to check the box above for None or Not Applicable*

PRIMARY (CORPORATE) OFFICE INFORMATION

(Use this format: mm-dd-yyyy)

PRIMARY CONTACT

SECONDARY CONTACT

CLAIMS CONTACT

OFFICERS

.

STOCKHOLDERS

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

(Identify union affiliations)
Do you have experience with projects that require Certified Payroll and Davis Bacon Wage Rate?

SERVICE CAPABILITIES

.
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SERVICES PROVIDED

(Select all services that apply)

Maximum file size: 5MB

STAFFING

.

OFFICE LOCATIONS & REGIONS SERVED

(Including primary office)
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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.

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:

Insurance Coverage

State your standard coverage limits in COLUMN 2 below.

POLICY

Occurrence (or claim) limit

Aggregate limit

GCL

Auto

Umbrella / Excess

Pollution / Liability

Workers Compensation

Professional Liability

Cyber / Network Security Liability


Health & Safety

Maximum file size: 134.22MB

Health & Safety (Cont.)

If Yes, does the training include:

Health & Safety (Cont.)

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

  Prior Year

Worker's Compensation
Experience Modification Rate (EMR)


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


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


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


Total Number of Hours Worked
(per occurrence)


The following upload fields allow for uploading of multiple files.
  1. To upload multiple files please click-and-hold the CTRL key and left-click with your mouse.
  2. Once you have selected the file(s) hit the "Open" button on the the dialog box.

Maximum file size: 10MB

Maximum file size: 10MB

Maximum file size: 10MB

Quality Assurance (QA) / Quality Control (QC) Practices

PERFORMANCE

Similar Contracts - List 3 contracts (within the last 5 years) for which your firm is providing services similar to those your firm is seeking to be prequalified for.
Client Type
Fee
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PRIOR CONTRACT WITH TECTONIC

If you have previously performed services for Tectonic, list up to 3 projects and the scope of work performed.
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PROJECT PERFORMANCE REFERENCES

List a minimum of 3 references for services performed within the last 3 years. REFERENCES MUST BE KNOWLEDGEABLE OF AND ABLE TO COMMENT ON YOUR FIRM’S ADHERENCE TO PROJECT BUDGETS AND SCHEDULES.
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PERFORMANCE ISSUES

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

LITIGATION / CONTRACT DISPUTES has the firm been subject to any of the following within the past 5 years?

Judgements
Liens
Insurance Claims
Lawsuits
If Yes to any of the above, have any rulings, outcomes, or judgements been made against the firm as a result?
(If "Yes", provide more information for each on a supplemental sheet.)

SUPPLEMENTAL INFORMATION

Required upload size: 10MB - 134.22MB

CERTIFICATION

The undersigned certifies, under penalty of law, that the information provided and the representations are accurate and current. Making false representations or providing inaccurate information may result with being disqualified as a prequalified consultant or in termination of a contract.

Please note: When you save the information as draft your attachments will also be saved.

FOR TECTONIC USE ONLY

Sending

Special Inspection Feedback Form

Special Inspection Feedback Form

Section

1 = Not reliable and 10 = Very reliable
1 = Not well and 10 = Extremely well
1 = Not Satisfied and 10 = Extremely Satisfied
1 = Not satisfied and 10 = Very satisfied

Section

1 = Not Satisfied and 10 = Very Satisfied
1 = Not Satisfied and 10 = Very Satisfied
1 = Not Satisfied and 10 = Very Satisfied
1 = Not Satisfied and 10 = Very Satisfied

Section

(Please fill only if you answered "Yes" in the previous question)
Please verify your input by checking the box below.
Sending

Service Evaluation

Service Evaluation

Section

Your name
The company you're working with
A contact phone number if you would like to be contacted (In this format XXX-XXX-XXXX)
Feel free to express your views of TECTONIC service.
Please verify your input by checking the box below.
Sending

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