Vendor Pre-Qualification | U.S.A. Maritime Industry Services

Vendor Information

Please complete the following Vendor Pre-Qualification form so U.S.A. Maritime Industry Services can evaluate your organization's capabilities, business information, insurance status, safety practices and relevant experience.

Information submitted through this form may be used to determine whether your organization may be considered for future vendor, supplier, subcontractor or service-provider opportunities.

Important: Submission of this form does not constitute vendor approval, create a contractual relationship, guarantee future work, guarantee inclusion on an approved vendor list, or obligate U.S.A. Maritime Industry Services to request services from the submitting organization.

1. Company Information

Legal Company Name *

DBA / Trade Name

Primary Contact *

Contact Title

Email Address *

Phone Number *

Business Address *

City *

State / Territory *

ZIP / Postal Code *

Company Website

2. Business Information

Year Established

Number of Employees

Business Structure

EIN / Tax ID

Services / Products Provided *

Geographic Service Area

3. Maritime Industry Experience

Maritime Experience

Maritime Services / Capabilities

4. Insurance Information

General Liability Insurance

Workers' Compensation

Commercial Auto Insurance

Professional Liability / E&O

Insurance Carrier

Policy Expiration

5. Safety & Performance

Written Safety Program

OSHA Citations Within the Past 3 Years

Citation Details

Licenses, Certifications & Qualifications

6. Business References

Reference 1 — Company

Reference 1 — Contact

Reference 1 — Phone / Email

Reference 2 — Company

Reference 2 — Contact

Reference 2 — Phone / Email

7. Certification

I certify that the information provided in this Vendor Pre-Qualification form is true and accurate to the best of my knowledge. I understand that submission does not guarantee vendor approval, future work, a contractual relationship or inclusion on an approved vendor list.

Authorized Representative *

Title *

Information submitted through this form will be sent to U.S.A. Maritime Industry Services for review.

Vendor Questions?

Contact U.S.A. Maritime Industry Services

Email: office@usamis.org
Phone: (407) 434-9859