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)

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|Please submit the following information from your most recent completed annual financial statements: |

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|Data reported for fiscal year: |

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|Current Assets |

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|Fixed Assets (Property, Plant and Equipment) |

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|Total Assets |

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|Goodwill (if applicable) |

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|Current Liabilities |

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|Long-term Debt |

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|Short-term loans, notes, and current portion of long term debt |

| |

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|Total Equity |

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|IF Total Equity (above) is less than $50M, enter the following: |

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|Cash from Operations OR Net Income (circle one) |

| |

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|IF Total Equity (above) is greater than $50M, enter the following: |

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|Earnings before income taxes (EBIT) |

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|Depreciation |

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|Interest expenses |

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|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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