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Contractor Prequalification Application Form

  1. (as it appears on your license)

  2. Department of Industrial Relations

  3. (Labor Code 1725.5, 1771.1, 1771.3, 1771.4, 1771.5, 1771.7, 1773.3, 1776)


  5. Construction Operations

  6. Annual Gross Revenue

  7. Contractor State License Board

  8. Classifications

  9. Required Attachments:

  10. 1. Firm's latest copy of reviewed and audited financial statement, with notes and supplemental information (information contained in this statement shall not be public records and shall not be open for public inspection);

  11. 2. W-9 request for taxpayer identification number and certification;

  12. 3. Certificate of liability insurance for all operation; Yuba Water Agency as additional insured;

  13. *Please email required attachments to

  14. I, the undersigned, certify and declare that I have read all the foregoing answers to this prequalification questionnaire and know their contents. The matter stated in the questionnaire answers are true to the best of my knowledge and belief. I declare under penalty of perjury under the laws of the State of California, the foregoing is correct.

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