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Contractor Qualification Form

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Vlaxy Villanueva
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31 views2 pages

Contractor Qualification Form

Uploaded by

Vlaxy Villanueva
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Contractor Qualification Form

Introduction: This form lists the contractor’s qualifications. Information provided on and attached to this form is to be kept and maintained confidential by all
parties and will not be used or disclosed other than as relative to projects for this owner and affiliated entities. Such information will only be disclosed to
others upon subpoena or other court or administrative order.
Contractor information List Street address – provide mailing address attachment

Catriz-Aire Aircon & Refrigeration Services


Company Legal Name Type of entity (Corp, LLC, etc.) Date Submitted:
Sole Proprietorship December 21, 2023
DBA (Doing Business As: Aircon Parts / Installation Services Years in operation: 4
Address: 3 rd
Floor Family Doc Clinic, Block 10 Lot 4, MRT Avenue, Central Signal Village, Taguig City
Phone: 0917 520
Fax: N/A Email: [email protected]
2776
Key Contact:
Names of other operations and locations and other parties if your company is a subsidiary or affiliation:
N/A
Personnel
Principal: Mr. Nelson M. Catriz Email: [email protected]
Other: Engr. Milfred C. Ortonio Email: [email protected]
Bonding and Banking: Attach letter from Banking Institute and additional information as needed
Bonding Company:
Agent: Phone: Email: Bonding Capacity:
Bank Reference: Provide a letter of good standing from your Banking Institution
Business Insurance: Provide copy of insurance certificate
General Liability Insurance carrier name:
Agent: Phone: Email:
Address:

Relevant project experience: Fire Protection System, Supply and Installation of Air-Conditioning & Ventilation
Company experience: List projects relevant to Owner’s type of construction – attach additional information

System

Deuces Food and


Name of project Firm rep. address/phone Owner Project construction cost Projected Complete

Ms. Rachel
Beverage 2,528,548.28
Deuces Coffee &
Debrosca
Corporation
Roastery - SM January 13, 2023

Engr. Jeff
Aura

January 27, 2023


Roldan
Shell Canvas Mr. Onyeng Lee 2,700,000.00
References: Architects / consultants, clients, sub-contractors - attach additional information

PGA Cars PGA Cars Ms. Beth Digoy 0917 581 6857
Company Discipline/Project Contact individual Phone/email:

Deuces
Ms. Rachel
Augustea Shipping Coffee + 0918 897 4131
Debrosca
Roastery
Engr. Jose
[email protected]
Danny Bayogos
di.ph
Everest
Everest International Academy
Academy

Licensed to Contract in: Attach additional sheets as needed


Name of license holder Jurisdiction License Number Type of License (General, Specialty, etc.

Legal standing Attach explanation


Has your firm or company been engaged in a lawsuit, arbitration or bankruptcy in the past (5) years? (If yes, please explain)

Conflict of Interest Attach explanation


It is not possible to define all circumstances that could constitute a conflict of interest. Some examples include: providing a direct personal benefit (including
gifts or favors) to an owner employee or his/her relatives in order to obtain a owner contract, forming business relationships or obligations that compromise
the objectivity of those awarding owner contracts, ecclesiastical officers having business dealings with the owner within the boundaries of the ecclesiastical
Contractor Qualification Form 23 September 2013 Page 1 of 2
Contractor Qualification Form
unit in which such person has decision-making responsibility, etc.
Do Principals and/or officers of your Company have any personal, business, or other relationships as set forth above and or otherwise with the owner, its
affiliated corporations, groups, or employees other than for providing professional services paid for by the Owner? (If yes, please explain)
Acknowledgement for Conflict of Interest Statement Signed:

Company Name: Catriz-Aire Aircon & Refrigeration Services


Submitted by: Company Principal
Date: Name of signatory: Signed
Mr. Nelson M. Catriz
Reviewed by: Project Manager
Date: Name of signatory: Signed

Comments:

Approval by: Area Project Manager


Date: Name of signatory: Signed

Comments:

Contractor Qualification Form 23 September 2013 Page 2 of 2

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