00420_Statement_of_Bidders_Qualifications_OpenGov.pdf

STATEMENT OF

CITY OF EDINBURG BIDDER’S QUALIFICATIONS

STATEMENT OF BIDDER'S QUALIFICATIONS

ARTICLE 1—GENERAL INFORMATION

1.01 Provide contact information for the Business:

Legal Name of Business:

Corporate Office

Name: Phone number:

Title: Email address:

Business address of corporate office:

Local Office

Name: Phone number:

Title: Email address:

Business address of local office:

1.02 Provide information on the Business’s organizational structure:

Form of Business: ☐ Sole Proprietorship ☐ Partnership ☐ Corporation

☐ Limited Liability Company ☐ Joint Venture comprised of the following companies:

1.

2.

3.

Provide a separate Qualification Statement for each Joint Venturer.

Date Business was formed: State in which Business was formed:

Is this Business authorized to operate in the Project location? ☐ Yes ☐ No ☐ Pending

1.03 Identify all businesses that own Business in whole or in part (25% or greater), or that are wholly or partly

(25% or greater) owned by Business:

Name of business: Affiliation:

Address:

Name of business: Affiliation:

Address:

Name of business: Affiliation:

Address:

1.04 Provide information regarding the Business’s officers, partners, and limits of authority.

Name: Title:

Authorized to sign contracts: ☐ Yes ☐ No Limit of Authority: $

Name: Title:

Authorized to sign contracts: ☐ Yes ☐ No Limit of Authority: $

Name: Title:

Authorized to sign contracts: ☐ Yes ☐ No Limit of Authority: $

Name: Title:

ARTICLE 2—LICENSING

2.01 Provide information regarding licensure for Business, if applicable:

Name of License:

Licensing Agency:

License No: Expiration Date:

Name of License:

Licensing Agency:

License No: Expiration Date:

ARTICLE 3—DIVERSE BUSINESS CERTIFICATIONS

3.01 Provide information regarding Business’s Diverse Business Certification, if any. Provide evidence of current certification.

Certification Certifying Agency Certification

Date

☐ Disadvantaged Business Enterprise

☐ Minority Business Enterprise

☐ Woman-Owned Business Enterprise

☐ Small Business Enterprise

☐ Disabled Business Enterprise

☐ Veteran-Owned Business Enterprise

☐ Service-Disabled Veteran-Owned Business

☐ HUBZone Business (Historically

Underutilized) Business

☐ Other

☐ None

ARTICLE 4—SAFETY

4.01 Provide information regarding Business’s safety organization and safety performance.

Name of Business’s Safety Officer:

Safety Certifications

Certification Name Issuing Agency Expiration

4.02 Provide Worker’s Compensation Insurance Experience Modification Rate (EMR), Total Recordable

Frequency Rate (TRFR) for incidents, and Total Number of Recorded Manhours (MH) for the last 3 years and the EMR, TRFR, and MH history for the last 3 years of any proposed Subcontractor(s) that will provide Work valued at 10% or more of the Contract Price. Provide documentation of the EMR history for Business and Subcontractor(s).

Year

Company EMR TRFR MH EMR TRFR MH EMR TRFR MH

ARTICLE 5—FINANCIAL

5.01 Provide Annual Gross Revenue (Past Year): $100,000 or less $100,000 - $500,000

$500,000 - $1,000,000 $1,000,000 - $5,000,000 $5,000,000 and over

5.02 Will bidder/proposer provide copy of its financial statements for the past two years, if requested by the

City of Edinburg? Yes No

ARTICLE 6—SURETY INFORMATION

6.01 Provide information regarding the surety company that will issue required bonds on behalf of the

Business, including but not limited to performance and payment bonds.

Surety Name:

Surety is a corporation organized and existing under the laws of the state of:

Is surety authorized to provide surety bonds in the Project location? ☐ Yes ☐ No

Is surety listed in “Companies Holding Certificates of Authority as Acceptable Sureties on

Federal Bonds and as Acceptable Reinsuring Companies” published in Department Circular 570

(as amended) by the Bureau of the Fiscal Service, U.S. Department of the Treasury?

☐ Yes ☐ No

Mailing Address

(principal place of business):

Physical Address

Phone (main): Phone (claims):

ARTICLE 7—INSURANCE

7.01 Provide information regarding Business’s insurance company(s), including but not limited to its

Commercial General Liability carrier. Provide information for each provider.

Name of insurance provider, and type of policy (CLE, auto, etc.):

Insurance Provider Type of Policy (Coverage Provided)

Are providers licensed or authorized to issue policies in the Project location? ☐ Yes ☐ No

Does provider have an A.M. Best Rating of A-VII or better? ☐ Yes ☐ No

Mailing Address

Physical Address

Phone (main):

Phone (claims):

ARTICLE 8—CONSTRUCTION EXPERIENCE

8.01 Provide information that will identify the overall size and capacity of the Business.

Average number of current full-time employees:

Estimate of revenue for the current year:

Estimate of revenue for the previous year:

8.02 Provide information regarding the Business’s previous contracting experience.

Years of experience with projects like the proposed project:

As a general contractor: As a joint venturer:

Has Business, or a predecessor in interest, or an affiliate identified in Paragraph 1.03:

Been disqualified as a bidder by any local, state, or federal agency within the last 5 years?

☐ Yes ☐ No

Been barred from contracting by any local, state, or federal agency within the last 5 years?

☐ Yes ☐ No

Been released from a bid in the past 5 years? ☐ Yes ☐ No

Defaulted on a project or failed to complete any contract awarded to it? ☐ Yes ☐ No

Refused to construct or refused to provide materials defined in the contract documents or in a change order? ☐ Yes ☐ No

Been a party to any currently pending litigation or arbitration? ☐ Yes ☐ No

Provide full details in a separate attachment if the response to any of these questions is Yes.

8.03 List all projects currently under contract in Schedule A and provide indicated information.

8.04 List a minimum of three and a maximum of six projects completed in the last 5 years in Schedule B and provide indicated information to demonstrate the Business’s experience with projects similar in type and cost of construction.

8.05 In Schedule C, provide information on key individuals whom Business intends to assign to the Project.

Provide resumes for those individuals included in Schedule C. Key individuals include the Project

Manager, Project Superintendent, Quality Manager, and Safety Manager. Resumes may be provided for

Business’s key leaders as well.

ARTICLE 9—REQUIRED ATTACHMENTS

9.01 Provide the following information with the Statement of Qualifications:

A. If Business is a Joint Venture, separate Qualifications Statements for each Joint Venturer, as required in Paragraph 1.02.

B. Diverse Business Certifications if required by Paragraph 3.01.

C. Certification of Business’s safety performance if required by Paragraph 4.02.

D. Financial statements as required by Paragraph 5.01.

E. Attachments providing additional information as required by Paragraph 8.02.

F. Schedule A (Current Projects) as required by Paragraph 8.03.

G. Schedule B (Previous Experience with Similar Projects) as required by Paragraph 8.04.

H. Schedule C (Key Individuals) and resumes for the key individuals listed, as required by

Paragraph 8.05.

I. Additional items as pertinent.

This Statement of Qualifications is offered by:

Business:

(typed or printed name of organization)

By:

(individual’s signature)

Name:

(typed or printed)

Title:

Date:

(date signed)

(If Business is a corporation, a partnership, or a joint venture, attach evidence of authority to sign.)

Attest:

(individual’s signature)

Name:

(typed or printed)

Title:

Address for giving notices:

Designated Representative:

Name:

(typed or printed)

Title:

Address:

Phone:

Email:

Schedule A—Current Projects

Name of Organization

Project Owner Project Name

General Description of Project

Project Cost Date Project

Completed

Key Project Personnel Project Manager Project Superintendent Safety Manager Quality Control Manager

Name

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference)

Name Title/Position Organization Telephone Email

Owner

Designer

Construction Manager

Project Owner Project Name

General Description of Project

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference)

Name Title/Position Organization Telephone Email

Owner

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference)

Name Title/Position Organization Telephone Email

Owner

Schedule B—Previous Experience with Similar Projects

Project Owner Project Name

General Description of Project

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference)

Name Title/Position Organization Telephone Email

Owner

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference)

Name Title/Position Organization Telephone Email

Owner

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference)

Name Title/Position Organization Telephone Email

Owner

Schedule B—Previous Experience with Similar Projects

Project Owner Project Name

General Description of Project

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference)

Name Title/Position Organization Telephone Email

Owner

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference)

Name Title/Position Organization Telephone Email

Owner

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference)

Name Title/Position Organization Telephone Email

Owner

Schedule C—Key Individuals

Project Manager

Name of individual

Years of experience as project manager

Years of experience with this organization

Number of similar projects as project manager

Number of similar projects in other positions

Current Project Assignments

Name of assignment Percent of time used for this project

Estimated project completion date

Reference Contact Information (listing names indicates approval to contact named individuals as a reference)

Name Name

Title/Position Title/Position

Organization Organization

Telephone Telephone

Email Email

Project Project

Candidate’s role on project

Candidate’s role on project

Project Superintendent

Name of individual

Years of experience as project superintendent

Years of experience with this organization

Number of similar projects as project superintendent

Number of similar projects in other positions

Current Project Assignments

Name of assignment Percent of time used for this project

Reference Contact Information (listing names indicates approval to contact named individuals as a reference)

Title/Position Title/Position

Organization Organization

Telephone Telephone

Email Email

Project Project

Candidate’s role on project

Candidate’s role on project

Safety Manager

Years of experience as project manager

Years of experience with this organization

Number of similar projects as project manager

Number of similar projects in other positions

Current Project Assignments

Name of assignment Percent of time used for this project

Reference Contact Information (listing names indicates approval to contact named individuals as a reference)

Title/Position Title/Position

Organization Organization

Telephone Telephone

Email Email

Project Project

Candidate’s role on project

Candidate’s role on project

Quality Control Manager

Years of experience as project superintendent

Years of experience with this organization

Number of similar projects as project superintendent

Number of similar projects in other positions

Current Project Assignments

Name of assignment Percent of time used for this project

Reference Contact Information (listing names indicates approval to contact named individuals as a reference)

Title/Position Title/Position

Organization Organization

Telephone Telephone

Email Email

Project Project

Candidate’s role on project

Candidate’s role on project