KBR Federal Services Partner Prequalification Form

If your company is interested in providing subcontract services for KBR Federal Services, LLC, please fill out the following form.  Items marked with an asterisk are required.
Information submitted via this form will be treated as confidential and will be used solely for the purpose indicated, and will not be disclosed to parties outside the KBR family of companies.

Company Overview
*Company Name:  
*Tax ID Number (TIN):  
*Address 1:  
 Address 2:  
*City:  
*State:  
*ZIP:  

*President's Name  
*Contact Name  
*Title  
*Email:  
*Phone:  
 Fax:  

*Parent or Affiliated Company:
  If applicable.
 		 

*How long has this company
 operated under the current name? 		      year(s)

*Has this company operated under any other name(s)? Yes No
  If yes, please provide previous company name(s), address(es), and phone number(s).
Previous Name
  
 Address
  
 Phone

 
 

 
 

 
 

Is your company presently ISO 9001:2000 or TL9000 certified?
    Yes
    No
What project(s) are you interested in providing subcontract services for?


I have read and agree to the terms and conditions of the KBR Federal Services Standard Subcontract Agreement.
    Yes
    No
Form W-9 & Reps and Certs Form
Please download, print, fill out, sign and date both the required W9 form and the Non-Commercial Items and Services Representations and Certifications form linked below.

  
 Download the W9 form *

  
 Download the Non-Commercial Items and Services Representations and Certifications form *

Please scan and submit the completed forms as attachments via e-mail to:

       Tonya.Busbee@KBR.com

Questions?  Contact:

Tonya Busbee
Procurement Specialist
KBR Federal Services, LLC
2000 International Park Drive
Birmingham, AL 35243

205.972.5483

Your application is incomplete without the associated W9 and Reps & Certs forms.  Please fill out each form in its entirety.  Please do not return the forms via Postal Mail.

Business Classification
Small business owners may qualify for specific Small Business Administration programs based on a variety of factors.  Please refer to the related SBA website resources to determine if you qualify for any of the small business categories listed below.

If you qualify, we encourage you to register your company with Central Contractor Registration at the Federal Business Partner Network (BPN).  Registering with CCR can increase your subcontracting opportunities for Federal Government projects.

*Business Classification (check all that apply)

     Large Business

     Small Business
For more information, see Am I a Small Business Concern? at SBA.gov.
     Small Disadvantaged Business (SDB)
For more information, see Small Disadvantaged Business Certification Questions & Answers (PDF) at SBA.gov.
     Women Owned Small Business (WOSB)
For more information, see Women Owned Small Businesses Program at SBA.gov.
     Veteran Owned Small Business (VOSB)
For more information, see Veterans Business Development at SBA.gov.
     Service Disabled Veteran Owned Small Business (SDVOSB)
For more information, see Veteran & Service-Disabled Veteran Owned at SBA.gov.
     HUBZone Small Business (HZSB)
For more information, see HUBZone Certification at SBA.gov.
     Historically Black Colleges, Universities & Minority Institutions

     DUNS Number   
   *Maximum Bonding Capacity   
   *Single Project Limit   

Experience
*State(s) and License Number(s) where Licensed to do Work
State Business License Number Contractor's License Number State Qualified?
 Yes  No
 Yes  No
 Yes  No
 Yes  No
 Yes  No
Yes No
Yes No
 
*Last 5 Large Contracts Completed
From
  
 To
  
 Client
  
 Services
  
 Contact
  
 Phone
  
 Value
 
  
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
 
 
  
 
 
 
 

*Geographic Areas of Operation
  
 		To select multiple entries,
press the Control key, then
click on each entry.

*Locations of Offices

 
*How long has your company worked at its present location?
   year(s)
 
What are the core services your organization performs in-house?
 
*Are there any material judgments, claims, or suits pending or outstanding against your company?
    Yes
    No

If yes, explain.
 
*Has your company ever been removed from a project?
    Yes
    No
 
If yes, explain.
 
*Are you currently involved in any litigation or arbitrations?
    Yes
    No
 
If yes, explain.
 
*Are you now, or have you ever been involved in any bankruptcy or reorganization proceedings?
    Yes
    No
 
If yes, explain.

Company Workforce
*Number of Permanent Employees


*Manpower in the last 3 years
Highest:   Lowest:

*Average annual business volume in past 3 years:   
Value of largest contract finished in past 3 years:
   
*Current backlog:   

Previous KBR Experience
Project  
 Date  
 Value

 
 

Safety Data
Please provide the EMR and Incidents data for the YTD and three years prior to the current year.

Contractors must furnish a letter from their insurance company verifying the EMR data listed below.
Click for more information regarding Insurance Company EMR Data verification letter
*Worker's Compensation Insurance Experience Modification Rate (EMR)
Policy Year       
 EMR
YTD
       
2010
       
2009
       
2008
       

*OSHA Recordable Incidents
     
 YTD
  
 2010
  
 2009
  
 2008
Number of employee hours worked
     
 
 
 
Number of lost workday cases
     
 
 
 
Number of fatalities
     
 
 
 
Total number of recordable cases
     
 
 
 

*Current Insurance Company (not insurance broker)

Safety & Health Programs
*Have you had an OSHA citation in the past five years?
    Yes
    No
 
If yes, explain.

*Do you have a documented Safety and Health Program?
    Yes
    No

If yes, are you willing to provide a copy upon request?
    Yes
    No

*Do you have a Safety Officer/Department in your company?
    Yes
    No

If yes, please provide the following information:

Safety Officer/Department Contact Name

Phone Number


*Does your company have a Substance Abuse Program,
designed to provide a Drug Free Workplace?
    Yes
    No

If  yes, does it include the following:

        Pre-Employment Screening?
            Yes
            No

        Random Testing?
            Yes
            No

        For Cause Testing?
            Yes
            No

If  no, would you agree to adhere to the KBR Federal Services
Group Substance Abuse Policy for Subcontractors?
    Yes
    No

*Do your supervisors and/or foreman receive formal safety training?
    Yes
    No

If yes, please explain.


*Are your supervisors and/or foreman trained in First Aid?
    Yes
    No

*Are your supervisors and/or foreman trained in CPR?
    Yes
    No

Please comment on any other areas of your company's Safety Program
and Policies that you feel will be appropriate in our evaluation.



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