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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



                                                      www.assurancescreening.com
                                                     ©2012Assurance Screening, LLC

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Assurance Screening - Screening Criteria Checklist

  • 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 www.assurancescreening.com ©2012Assurance Screening, LLC