Annual Prequalification – West Point Contractors

*This form is only to be used to complete an Annual Prequalification Update to include updated Financials, EMR, and OSHA documents. All information provided below will be reviewed securely and confidentially by a limited number of people and then destroyed.

General Information
Company Name*
Completed By:*
Email Address*
Contact Phone Number*
Financial Information
Annual Contract Volume*
Average Annual Sales for the Past 3 Years
Please provide average sales for the past 3 years
Average Sales*
Average Sales*
Average Sales*
Current Financial Statement*
Accepted file types: pdf, doc, docx, Max. file size: 20 MB.
Litigations Information
For any "yes" answer in this section, be advised that West Point may request some or all additional information available after review of your Prequalification.
Active Litigations Cases?*
- Yes
- No
Judgements Filed Against This Company?*
- Yes
- No
A History of Contract Default or Contract Termination?*
- Yes
- No
Experience Modification Rate (EMR)
List your company's Experience Modification Rate (EMR) for the past three (3) years.
Year*
EMR*
Year*
EMR*
Year*
EMR*
OSHA Log Information
Please provide your company's injury experience for the last three (3) years as reported on your OSHA 300 log.
Year*
Total Number of Injury and Illness Cases*
Total Number of Cases With Days Away From Work*
Total Number of Cases With Job Transfer or Restriction*
Total Number of Fatalities*
Total Number of Hours Worked*
DART Incidence Rate*
Year*
Total Number of Injury and Illness Cases*
Total Number of Cases With Days Away From Work*
Total Number of Cases With Job Transfer or Restriction*
Total Number of Fatalities*
Total Number of Hours Worked*
DART Incidence Rate*
Year*
Total Number of Injury and Illness Cases*
Total Number of Cases With Days Away From Work*
Total Number of Cases With Job Transfer or Restriction*
Total Number of Fatalities*
Total Number of Hours Worked*
DART Incidence Rate*
Additional Documentation
For optimal consideration, you should upload all of the documents requested. Starred items are required.
EMR Letter of Verification*
Accepted file types: pdf, doc, docx, Max. file size: 20 MB.
OSHA 300 Forms*
Accepted file types: pdf, doc, docx, Max. file size: 20 MB.
Current Contractor's License(s)*
Accepted file types: pdf, doc, docx, Max. file size: 20 MB.
Current W9*
Accepted file types: pdf, doc, docx, Max. file size: 20 MB.
CAPTCHA

*All information provided below will be reviewed securely and confidentially by a limited number of people and then destroyed.

General Information

Financial Information

Average Annual Sales for the Past 3 Years

Litigations Information

Experience Modification Rate (EMR)

OSHA Log Information

Additional Documentation