1. Screening Criteria Checklist
Company Name:
Contact Name:
Date of Checklist:
Email:
Phone:
With Assurance Screening’s customizable screening parameters, your organization can have the peace of mind knowing that your
subcontractors and trade partners have the right insurance, bonding capacity, licenses, or other types of credentials required to work
with your organization.
Please review the options below and select the type and frequency of each criteria required for your organization. Utilize the custom-
izable options to allow Assurance Screening to collect and verify additional information specific to your firm. Assurance Screening
will confirm back with your team if these additional requests can be added.
Documentation Collections Screenings & Verifications
___ Insurance certificate collection and agency verification ___ Business entity verification
___ 1x
___ Quarterly ___ The Experian™ Business Profile Report
___ Monthly ___ 1x
___ Other ___ Quarterly
___ Monthly
___ Prequalification Statement collection ___ Other
Professional/trade license collection & verification ___ Bankruptcy/Tax Lien & Judgments check
___ 1x ___ 1x
___ Quarterly ___ Quarterly
___ Monthly ___ Monthly
___ Other ___ Other
___ MBE/DBE certification collection and verification ___ 5-year OSHA citation/violation/fine search
___ 1x
___ W9 collection and record search ___ Quarterly
___ Monthly
___ Bonding reference letter collection and verification ___ Other
___ 1x
___ Semi-annually ___ Project reference verifications
___ Quarterly (3 references. Up to 5 attempts)
___ Other
___ Supplier payment verifications
___ Banking reference letter collection (3 suppliers. Up to 3 attempts)
___ 3 year EMR collection and verification ___ Other
___ 1x
___ Other ___ Quarterly
___ 1x ___ Monthly
___ Quarterly ___ Other
___ Monthly
___ Other ___ Other
___ 1x
___ Quarterly
___ Monthly
___ Other
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