Contractor Profile: ABC Painting
General Information (Required)
|Company Name | | |Date Company | |
| | | |Established | |
|Physical Address | | | | |
| | | |Form of Business |□ Sole Owner |
| | | | |□ Partnership |
| | | | |□ Corporation |
| | | | |□ LLC |
| | | | |□ LP |
| | | | |□ Other |
| | | |Minority Owned |□ Yes |
| | | | |□ No |
|Mailing Address | | | | |
| | | | | |
|□ Check Here if | | | | |
|Same as Above | | | | |
| | | |Union Affiliation |□ Yes |
| | | | |□ No |
| | | |Full Time Employees| |
|Web Address | | | | |
|Federal Tax ID # | | | | |
Contact Information (Required)
|Contact Area |Contact Name |Phone |Email |
|General | | | |
|OQ | | | |
|□ NA | | | |
|□ Use General | | | |
|PHMSA Drug/Alcohol | | | |
|□ NA | | | |
|□ Use General | | | |
|Health and Safety | | | |
|□ NA | | | |
|□ Use General | | | |
|Environmental | | | |
|□ NA | | | |
|□ Use General | | | |
|Insurance | | | |
|□ NA | | | |
|□ Use General | | | |
|Financial | | | |
|□ NA | | | |
|□ Use General | | | |
Parent Company/Affiliate Companies (Optional)
|Name of Parent Company | | |Affiliate Companies |
|□ Check Here if NA | | |□ Check Here if NA |
|Physical Address | | | |
|Mailing Address | | | |
|□ Check Here if Same as Above| | | |
|Web Address | | | |
Products/Services (Required)
|NAICS Code |Primary | |States Where You Provide Products/Services |
| | | |(Circle all that apply) |
| |Secondary | | Pacific Northwest |
| | | |(AK,ID, OR, WA) |
| | | | |
| | | |Pacific South |
| | | |(AZ, CA, HI, NV) |
| | | | |
| | | |Rocky Mountain |
| | | |(CO, MT, ND, NM, SD, WY, UT) |
| | | | |
| | | |Central Plains |
| | | |(IA, KS, MO, NE) |
| | | | |
| | | |Southwest |
| | | |(AR, LA, OK, TX) |
| | | | |
| | | |Southeast |
| | | |(AL, FL, GA, KY, MS, NC, SC, TN) |
| | | | |
| | | |Great Lakes |
| | | |(IL, IN, MI, MN, OH, WI) |
| | | | |
| | | |Mid-Atlantic |
| | | |(DE, MD, NJ, PA, VA, WV) |
| | | | |
| | | |Northeast |
| | | |(CT, MA, ME, NH, NY, RI, VT) |
|SIC Code |Primary | | |
|(optional) | | | |
| |Secondary | | |
|Note: | | |
| | | |
|For assistance in identifying the appropriate codes above, the | | |
|following websites may be of help: | | |
| | | |
|NAICS Code | | |
| | | |
| | | |
|SIC Code | | |
| | | |
|What principle line of work do you propose to perform for Spectra Energy? |
|(Circle all that apply) |
| Aerial Pipeline Crossing | Fire Protection Equipment Services – Onsite | Pipeline Operations |
| Air Compressor Service | Gas Evacuation | Pipeline Recoats, Anomalies, Clock Spring |
| Anode Installation (excavation) | Gas Well Services | Pipeline Rehab |
| Anode Installation (no excavation) | General Construction - Building Installation | Piping/Vessel Insulation |
| Archeological/Geological Survey | General Construction - Carpentry | Plant Construction |
| Asbestos Abatement | Generator Services (< 480 volt) | Plumbing |
| Audio/Visual Services | Generator Services (> 480 volts) | Power Washing |
| Aviation Services | Ground Surface Restoration (ROW) | Refractory Repair (w/confined space) |
| Blasting | Hazardous Material/Waste/PCB Transportation | Refractory Work |
| Boat Service/Rental | Hazardous Waste/PCB Material Treatment and Disposal| Regrouts |
| Boiler Service | | Roofing (< 3 stories) |
| Boiler Service (w/confined space) | Heat Treating/Stress Relieving | Roofing (> 2 stories) |
| Cable Work (power wires) |Herbicide Application | ROW Clearing and Grubbing |
| Cable Work - IT type (> 2 stories) | High voltage electrical work (energized work > 480 | ROW Mowing |
| Cabling Work - IT type (< 3 stories) |volt) | ROW Mowing (flat ground w/ no above ground pipe) |
| Cafeteria Services, Catering | Hot Taps | Rug Rag Service |
| Camera/Borescope Inspection | HVAC Services (< 3 stories) | Sandblasting |
| Cathodic Protection Installation | HVAC Services (> 2 stories) | Security Equipment Maintenance |
| Cathodic Protection Surveys / Inspections | Hydro-Vac Excavation | Security Services |
| Chemical Cleaning | Hydrostatic/Pressure Testing | Shoring Work |
| Civil/Dirt Work | In-service Casing - Removal, Installation, Cleaning| Snow Removal (< 10' from above ground gas facility)|
| Coffee Service | | |
| Communication Tower Work (< 3 stories) | Industrial Hygiene | Snow Removal (> 10' from above ground gas facility)|
| Communication Tower Work (> 2 stories) | Inline Tool Work | |
| Computer Service | Insecticide Application | Soil Sampling (by hand) |
| Concrete Work | Inspection - site | Soil Sampling (power equipment) |
| Consulting - hands on machinery | Interior Work - Carpet, Tile, DTcor, Painting | Spill/Emergency Response |
| Consulting Services | Janitorial | Staffing |
| Crane Service and Rigging | Large Equipment Installation/Repair | Stopple Service |
| Cryogenics | Lawn and Grounds Maintenance, Landscaping | Structure Demolition |
| Delivery Services (Industrial) | Lead Abatement | Survey Work |
| Delivery Services (Office) | Leak Survey | Switch Gear Maintenance |
| Diving Services | Line Locating - probing | Tank/Equipment Cleanout |
| Drilling and Boring | Line Locating - with instrumentation | Torqueing/Tensioning |
| Electrical Work (energized work < 480 volt) | Low Voltage Instrumentation | Traffic Control |
| Electricity Generation and Transmission | Material Handling | Tree Maintenance |
| Emissions Testing (< 3 stories) | Mechanical (Millwright, Pipe Fitter) | Turbine/Compressor/Engine Services |
| Emissions Testing (> 2 stories) | Meter Work | Unit Overhaul |
| Environmental Remediation | NDE/Radiography | Vacuum Truck Services |
| Equipment and Trailer Leasing | Non-Hazardous Waste/Material Treatment and | Valve & Operator Installation/Maintenance |
| Erosion Control |Disposal | Vehicle Radio Installation |
| Excavation (near underground systems) | Odorant Survey | Water Well Services |
| Excavation - hand | Office Equipment Services | Welding on live gas facilities |
| Fabrication Offsite | Overhead Crane/Hoist Maintenance | Window Washing (> 2 stories) |
| Fabrication on-site | Paving and Resurfacing | Work at Vendor facility |
| Fencing | Pipeline Coating | |
| | Pipeline Construction | |
Environmental, Health and Safety Information (Required)
Please submit a copy of your OSHA 300 Logs
|□ Check here if your company is not required to maintain OSHA 300A logs. In this |2011 |2010 |2009 |
|case, you are only required to provide the EMR data. | | | |
|Experience Modification Rate (EMR) | | | |
|Number of Health and Safety Citations/Violations | | | |
|Number of Health and Safety Charges/Convictions | | | |
|Number of Environmental Citations/Violations/Orders | | | |
|Number of Environmental Charges/Convictions | | | |
|Hours Worked | | | |
|Total Number of Deaths | | | |
|“G” on 300A log | | | |
|Total Number of Cases With Days Away From Work | | | |
|“H” on 300A log | | | |
|Total Number of Cases With Job Transfers or Restrictions | | | |
|“I” on 300A log | | | |
|Total Number of Other Recordable Cases | | | |
|“J” on 300A log | | | |
| |
|Definitions: |
| |
|Lost Workday Case – incident/case which, as a result of a work-related injury/illness, affects the injured employee to the extent |
|that days must be taken off from the job for medical treatment or recuperation. |
| |
|Restricted Workday Case – incident/case which, as the result of a work-related injury/illness, an employee or health care |
|professional keeps, or recommends keeping, an employee from doing the routine functions of his/her job or from working the full |
|workday that the employee would have been scheduled to work before the injury/illness occurred. |
| |
|Other Recordable Cases – incident/case that does not fall into the category of lost workday case, restricted workday case or |
|fatality. |
| |
Financial Information (Required)
| |
|Please submit the following information from your most recent completed annual financial statements: |
| |
|Data reported for fiscal year: |
| |
| |
|Current Assets |
| |
| |
|Fixed Assets (Property, Plant and Equipment) |
| |
| |
|Total Assets |
| |
| |
|Goodwill (if applicable) |
| |
| |
|Current Liabilities |
| |
| |
|Long-term Debt |
| |
| |
|Short-term loans, notes, and current portion of long term debt |
| |
| |
|Total Equity |
| |
| |
|IF Total Equity (above) is less than $50M, enter the following: |
| |
|Cash from Operations OR Net Income (circle one) |
| |
| |
|IF Total Equity (above) is greater than $50M, enter the following: |
| |
|Earnings before income taxes (EBIT) |
| |
| |
|Depreciation |
| |
| |
|Interest expenses |
| |
| |
|Source of the above provided financial data: Audited with clean opinion by auditing firm, Reviewed and compiled by auditing firm, |
|or Unaudited. (Circle one) If results have been audited, supply a copy of auditor’s opinion. |
| |
|Definitions: |
|All terms used above are defined in terms of GAAP. |
| |
| |
|Note: This information will be used for the sole purpose of allowing Spectra Energy to evaluate the financial strength of your |
|company. None of this information will be released or reported to any other party. |
Note: All information must be provided in order for this questionnaire to be processed.
Please return completed questionnaire and OSHA 300 Logs to:
SETcontractorapproval@ (preferred)
OR
Or fax to 281-404-7161
Attn: SET Contractor Approval Representative
OR
Veriforce, LLC
ATTN: SET Contractor Approval Dept
19221 I-45 South, Suite 200
Shenandoah, TX 77385
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