Subcontractor Qualification Form

Are you a Subcontractor or Supplier that is interested in working for Messer?  Take this opportunity to join our team by filling out the following Qualification Form.

General Information

All General Information fields are required except Web Address.

Disadvantaged Business Status

If applicable, you must mail, fax or e-mail a copy of your certification.

  Certifying Agency Certification No. Expiration Date
Contact information
  Name E-mail Address

If you provide project based labor, you must fill out the Field Performance, Safety and Insurance contact information.

Performance

You must check at least one.

You must check at least one.

 
Projects

Only subcontractors are required to complete the remainder of this form (i.e., if you provide field labor, you must complete the following questions).

List the three largest projects completed in the last two years, including references, contacts and phone numbers.

All project fields are required.

 
 

 
 

 
 

State the annual dollar amount of work performed during the last three years

List the number of field foremen and craft workers/field technicians presently employed by your company

If yes, is your DFWP certified by the State of Ohio BWC? (Only applicable if you perform work in Ohio.)

Safety

Workers' Comp EMR

Not required for companies established after 2009.

Experience Modification Rate — as provided by your Workers’ Compensation insurance provider.

OSHA 300

This section must be completed using the OSHA 300 form (see formulas).

Not required if company has less than 10 employees or established after 2009.

  2013 2012 2011
Professional Services
References

List three current business customers (local or otherwise) which have been or are now your customers.

Company Name Contact Name Phone Number
Review

Please take a moment to validate the information provided.

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When you are done, submit the form below.