Quick contact info

If you would like to get additional information, please contact:

icon_widget_image Monday-Friday: 9am to 5pm; Satuday: 10ap to 2pm icon_widget_image 24 Taylor Avenue P.O. Box 420 Bethel, Connecticut 06801 icon_widget_image (203) 797-8788 FAX: 203-791-2515 icon_widget_image worth@worthconstruction.com

Become a Subcontractor

    Company info
    Has the Company operated under any other name(s) in the past five years? YesNo


    Company Address
    Do you have Additional Mail Address? YesNo
    Has the Company changed address(es) in the past five years? YesNo
    Does the Company have offices, plants or warehouses at other addresses? YesNo


    Business Organization and History
    Does the Company share office space, staff, or equipment (including telephone exchanges) with any other business or organization? YesNo

      Instructions: In the following Section, fill in the required information on all present and past Key People for the past five years. “Key People” include: Principals, directors, officers. Shareholder of 5% or more of the Company issued stock. Any manager or individual who participates in overall policy-making or financial decisions for the Company. Any person in a position to control and direct the firm’s overall operations. Signatories to bank accounts and any debt instruments, whether or not otherwise considered Key People. “Shareholders” are owners of stock or other securities that can be converted to stock that, if exercised, would constitute 5% of the Company issued stock. Other securities include stock options, secured or unsecured bonds, warrants and rights.  

    Identify all Key People
    Add More? YesNo
    Add More? YesNo
    Add More? YesNo
    Add More? YesNo
    At present or during the past five years have any of the Key People of the Company served as a Key Person (see definition on page 3) or owned 5% or more of any other firm (including firms that are inactive or have been dissolved? YesNo
    Add More? YesNo
    Add More? YesNo
    Add More? YesNo
    Add More? YesNo


    Financial Information
    Has the Company, or its affiliates, or any of its Key People, been a party to a bankruptcy or reorganization proceeding? YesNo
    Add More? YesNo
    Add More? YesNo
    Add More? YesNo
    Add More? YesNo


    Does the Company have a bonding capacity? YesNo
    In writing bonds for the Company, does the surety company rely on the indemnity of any other firm(s) or individual(s)? YesNo
    What is the Company’s bonding capacity ($):
    Has the Company or any of its officers, owners or managers had any business related licenses, certificates or certifications revoked in the past 5 years? YesNo


    Compliance Information
    In the past five years has the Company or any of its affiliate firms been the subject of any of the following actions by any government agency (Government agencies include city, state, federal public agencies, quasi-public agencies, authorities and corporations, public development corporations and local development corporations):
    Been suspended, debarred, disqualified, had its prequalification revoked or otherwise been declared ineligible to bid or to perform work? YesNo
    Been barred from bidding or denied a contract as a result of refusal of Key People to testify before a grand jury or administrative board? YesNo
    Been denied a contract despite being the low bidder for any other reason? YesNo
    Been defaulted on any contract? YesNo
    Had a contract terminated for “cause”? YesNo
    Been given a final unsatisfactory performance determination or deemed a poor performer (by letter or formal proceedings)? YesNo
    Been prevented, or barred from bidding for any other reason? YesNo
    Been denied a contract for failure to obtain surety or otherwise provide required security? YesNo
    Had liquidated damages assessed against it, upon completion of a contract or failure to complete a contract? YesNo
    Add More? YesNo
    Add More? YesNo


    Compliance Information (Part II)
    In the past ten years has the Company or any of its current or past Key People or affiliate firms:
    Been under investigation, involving any alleged violation of criminal law relating to business activities? YesNo
    An INVESTIGATION includes an appearance before a grand jury by representatives of a business entity, any oral or written inquiry or review of the entity’s documents by a public agency, temporary commission or other investigative body including, but not limited to, subpoenas and/or search warrants, or questioning of employees concerning the general operation or a specific project of activities of such business entity.
    Had records in its or his/her control, custody or ownership subpoenaed by any law enforcement agency? YesNo
    Been questioned by any officer or agent of a law enforcement agency regarding any practices or conduct relating to the providing of construction related services? YesNo
    Been advised of being the target or subject of an investigation involving any violation of criminal law? YesNo
    Been notified or being the subject of court ordered electronic surveillance? YesNo
    Been arrested or indicted or otherwise named as an unindicted co-conspirator in any indictment or other accusatory instrument? YesNo
    Been convicted, after trial or by plea, of any felony under state or federal law? YesNo
    Been convicted of any misdemeanor involving business-related crimes? YesNo
    Entered a plea of nolo contendere to a charge of embezzlement, theft, forgery, bribery, falsification or destruction of records, receiving stolen property or a violation of the antitrust law? YesNo
    Entered into a consent decree? YesNo
    Been granted immunity from prosecution for any business-related conduct constituting a crime under state or federal law? YesNo
    Taken the Fifth Amendment in testimony regarding a business related crime? YesNo
    Been required to engage the services of an integrity monitor in connection with the award of, or in order to complete, any public or private contract? YesNo
    Do any current or past Key People listed in this application have any felony or misdemeanor charges pending against them that were filed either before, during or after their employment with the Company? YesNo