Subcontractors Olgoonik Inspection Services relies on the talent and reputation of its subcontractors. We work hard to build lasting partnerships with qualified, proven subcontracting companies. Subcontractor Qualification Form Please complete the following to the best of your ability. We realize that the information requested may not apply to every subcontractor. If you are a supplier, rather than listing previous experiences on past projects, please provide recent data on projects for which you have supplied material. Company Name*SpecialtyContact Person* First Last TitleAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Cellular PhoneWebsite Email* NAICSBusiness StatusCheck all that apply. Large Business Small Business Small Disadvantaged Business Woman-Owned Small Business Minority Business Enterprise Veteran-Owned Small Business Service-Disabled Veteran-Owned Small Business Historically Black College or University/Minority Institution/Tribal Universities Number of Employees*Number of Years in Business*Annual Volume*Please indicate if your firm is registered with any of the following Small Business Administration (SBA) programs: HUB Zone Certification Certified Small disadvantaged Business Program 8(a) Certification Program Is your firm bondable?* Yes No Has your firm performed work on a project that required submission of certified payroll?*YesNoHas your firm performed work in Alaska?*YesNoDoes your firm have a Substance Abuse Program?*YesNoDoes your firm have a Safety Program?*YesNoWhat is your current EMR (Experience Modification Rating)?*Multiplier used in Workers Compensation premium calculations to recognize accident experience.Typical Range of Project PerformedAverage ProjectSmallest ProjectLargest ProjectAny additional information about your firm (brochures, references, list of current projects and contract amounts, etc.) that you can provide will be appreciated.Please tell us where you learned about this subcontracting opportunity: