01020_HCPS_Contractors_Qualification_Statement_06-29-22.pdf

CONTRACTOR’S QUALIFICATION STATEMENT

HCPS STANDARDS DOCUMENT. No.: 01020

APPLICATION: ELEMENTARY, MIDDLE AND HIGH SCHOOL

DATE OF ISSUE:

06-29-22 - Update Hillsborough County Public Schools Logo

09-16-21 - Add request for name and e-mail address of contact person

03-06-20 - Deleted request to provide financial statement & revised acknowledgement page

04-26-13 - Revised threshold requirement for bonding from $100K to $300K.

10-22-09 - First Issue

NOTES:

Contractors submitting bids for construction projects advertised by THE SCHOOL BOARD OF HILLSBOROUGH COUNTY, FLORIDA, are permitted to use the following Contractor’s Qualification Statement in lieu of AIA Document A305.

ATTACHMENTS:

HCPS Contractor’s Qualification Statement, dated 09-16-21 (5 pages)

Hillsborough County Public Schools

Contractor’s Qualification Statement

Revised 06-09-2022 Page 1 of 5

FROM:

(Legal Name of Business)

(Mailing Address of Principal Office)

(City, State, Zip)

(Contact Person) (Telephone Number)

(Contact Person’s E-Mail Address)

TO: Hillsborough County Public Schools

ATTN: Operations Division, 2nd Floor

Velasco Student Services Center

1202 E. Palm Avenue, Tampa, Florida 33605

FOR:

(Name of Project)

CLASSIFICATION OF WORK:

(Check only one.)

[ ] General Construction [ ] Sitework [ ] HVAC [ ] Electrical

[ ] Plumbing [ ] Other:

The undersigned, being first duly sworn, hereby deposes and affirms that the following information is true and sufficiently complete so as not to be deceptive.

ORGANIZATION

YEARS IN BUSINESS:

(Number of years as a Contractor performing the classification of Work indicated. Check only one.)

[ ] < 3 [ ] 3+ [ ] 5+ [ ] 10+ [ ] 15+ [ ] 20+

BUSINESS NAME:

How many years has your organization been in business under its current name?

List other or former names under which your organization has operated:

Revised 06-09-2022 Page 2 of 5

BUSINESS STRUCTURE:

(Check only one and provide the related information.)

[ ] Corporation

Date of Incorporation:

State of Incorporation:

President’s Name:

Vice-President’s Name:

Secretary’s Name:

Treasurer’s Name(s):

[ ] Partnership

Date of Organization:

Type of Partnership:

Names of General Partners:

[ ] Individual

Name of Owner:

[ ] Other (Please specify.)

Type of Organization:

Name of Principal(s):

LICENSING:

List jurisdictions and trade categories in which your organization is legally qualified to do business:

(Indicate license or registration numbers where appropriate.)

Revised 06-09-2022 Page 3 of 5

List jurisdictions in which your organization’s partnership or trade name is filed:

EXPERIENCE:

List categories of work typically performed by your organization’s own forces:

CLAIMS AND SUITS:

(Attach a separate sheet detailing the circumstances for any of the following questions to which the answer is “yes.”)

Has your organization ever failed to complete any work awarded to it? [ ] Yes [ ] No

Are there any judgments, claims, arbitration proceedings or suits pending or outstanding against your organization or its officers? [ ] Yes [ ] No

Has your organization filed any law suits or requested arbitration pertaining to any construction contract(s) within the last five years? [ ] Yes [ ] No

Has any principal or officer of your organization ever been a principal or officer of another organization when it failed to complete any construction contract(s) within the last five years? [ ] Yes [ ] No

CURRENT WORKLOAD:

On a separate sheet, list the major construction projects currently being executed by your organization.

Identify the name of the project, owner, and architect, the contract amount, percentage complete and scheduled completion date.

What is the total worth of work in progress and under contract? $

RECENT WORKLOAD:

On a separate sheet, list the major construction projects completed within the last five years by your organization. Identify the name of the project, owner, and architect, the contract amount, percentage of the cost of work performed by your organization’s own forces and the completion date.

What is the average annual amount of construction work completed by your organization within the last five years? $

KEY PERSONNEL:

On a separate sheet, list the construction experience and present commitments of your organization’s key personnel.

Revised 06-09-2022 Page 4 of 5

REFERENCES:

Trade References:

(Name of Individual) (Name of Individual)

(Name of Business) (Name of Business)

(Mailing Address) (Mailing Address)

(City, State, Zip) (City, State, Zip)

(Telephone) (Telephone)

Bank References:

(Name of Individual) (Name of Individual)

(Name of Financial Institution) (Name of Financial Institution)

(Mailing Address) (Mailing Address)

(City, State, Zip) (City, State, Zip)

(Telephone) (Telephone)

Surety:

(Required only for projects with a construction cost in excess of $300,000.)

Bonding Company: Agent:

(Legal Name of Business) (Name of Individual)

(Mailing Address of Principal Office) (Legal Name of Business)

(City, State, Zip) (Mailing Address of Principal Office)

(City, State, Zip)

(Telephone)

Revised 06-09-2022 Page 5 of 5

SIGNATURE AND AFFIDAVIT OF CORPORATE REPRESENTATIVE:

Signed, sealed, and delivered this day of , 20 , By:

(Signature of Affiant)

(Printed Name of Affiant)

(Title of Affiant)

Corporate Seal

(Legal Name of Business)

STATE OF FLORIDA

COUNTY OF __________________

The foregoing instrument was acknowledged before me by means of physical presence or online notarization, this ______________________ by __________________________, ___________________ (Date) (Name of Officer or Agent) (Title of Officer or Agent) of __________________________________________, a _________________________ corporation, on (Name of Corporation Acknowledging) (State or Place of Incorporation) behalf of the corporation. He/She is personally known to me or has produced _______________________ (Type of Identification) as identification

(Signature of Notary Public)

(Name Typed, Printed or Stamped

My Commission Expires: _ _

Notary Seal (Date)