APPENDIX G

SUBCONTRACTOR’S STATEMENT OF QUALIFICATIONS

Required where the value of the subcontract is fifty-thousand ($50,000) or five percent of project value, whichever is greater. The project value is $11,725,715.00

PART 1

ORGANIZATION

Name:

Address:

Principal Office:

[ ] Corporation [ ] Partnership [ ] Sole Proprietorship [ ] Joint Venture

[ ] Other

f. How many years has your organization been in business as a Contractor?

g. How many years has your organization been in business under its present business name?

h. Under what other or former names has your organization operated?

1. LICENSING and RESPONSIBILITY MATTERS

a. Name of license holder (or qualifying party) exactly as on file with the State of New Mexico

Construction Industries Division:

b. License Classification: License Code:

c. License Number:

d. Issue Date: Expiration Date:

e. Is the firm’s contractor’s license free of ever being suspended or revoked by the CID or by the appropriate licensing agency in any other state?

[ ] Yes, Free of suspension or revocation [ ] No (Explain)

f. Does your firm hold all applicable Business licenses required by State (New Mexico) or

Local Public Bodies?

License Number: Jurisdiction:

Name of License Holder, exactly as it appears on file with jurisdictional authorities.

Issue Date: Expiration Date:

g. Is your firm and/or any of its Principals free from formal or proposed debarment from public works, federal, state or local jurisdictions?

[ ] Yes [ ] No (attach explanation)

h. Is your firm and/or any of its Principals free from conviction of or from judgments rendered against them for commission of fraud or criminal offenses in connection with obtaining or performing public works, federal, state or local jurisdictions?

i. Is your firm and/or any of its Principals free from notification of any delinquent federal, state or local taxes in an amount that exceeds three thousand dollars ($3,000.00) of which the liability remains unsatisfied?

2. EXPERIENCE

a. List 5 or more completed public or private projects where your contract was worth more than

$3 million.

Project Name Approximate worth of contract

b. State the average annual amount of construction work performed during the past five years:

c. List the categories of work that your organization normally performs with its own forces.

3. KEY PERSONNEL EXPERIENCE

Please note that more consideration will be given to those meeting or exceeding the required qualifications stated below.

a. Does your assigned Project Manager have the following minimum qualifications and experience?

(1) At least ten (10) years’ experience in the construction industry?

[ ] Yes [ ] No Number Years:

(2) Experience as a Project Manager on one (1) or more construction projects valued at 3 million dollars ($3,000,000) or more?

[ ] Yes Number Projects: [ ] No

b. Does your assigned Project Foreman have the following minimum qualifications and experience?

(1) At least ten (10) years’ experience in the construction industry?

[ ] Yes Number Years: [ ] No

(2) Experience as a Project Foreman on one (1) or more construction projects valued at $3,000,000 or more?

[ ] Yes Number Projects: [ ] No

c. Does your assigned Safety Program Manager have the following minimum qualifications and experience?

(1) At least five (5) years’ experience in a safety management role and OSHA 30?

[ ] Yes Number Years: [ ] No

d. List the individuals your firm will assign as your project management team, and the roles/functions each individual will perform.

(1) Project Manager: Years with your firm:

Present Position/Job Title: Years in this Position:

Is your Project Manager a Principal or Officer of the firm? [ ] Yes [ ] No

(2) Superintendent/Foreman: Years with your firm:

Is your Superintendent/Foreman a Principal or Officer of the firm? [ ] Yes [ ] No

(3) Safety Manager: Years with your firm:

Is your Safety Manager a Principal or Officer of the firm? [ ] Yes [ ] No Is your Safety Manager a company employee? [ ] Yes [ ] No

(4) QA/QC Manager: Years with your firm:

Is your QA/QC Manager a Principal or Officer of the firm? [ ] Yes [ ] No

4. CAPACITY AND CAPABILITY TO PERFORM THE WORK

a. Resources of the Company.

Total number of current employees:

(1) Project Managers

(2) Estimators

(3) Superintendents

(4) Foremen

(5) Tradesmen

(6) Administration

(7) Others

(8) Total Employees _______________________________________

(9) Total employees in New Mexico _________________________

5. SURETY

a. Firm’s current surety company:

Will this surety be used for the construction contract for this project?

[ ] Yes [ ] No (explain)

Contact Agent Name: Telephone:

Years utilizing this surety: Maximum Capacity:

Aggregate Total of current surety in force:

b. Is the surety company to be used on this project licensed to do business in the State of New Mexico?

[ ] Yes [ ] No (explain)

c. Is your firm free of having any construction contracts taken over by a surety for completion in the past five (5) years

[ ] Yes [ ] No (Explain)

d. Has your firm used other surety companies since 2015?

[ ] Yes (list) [ ] No

Surety company Contact

e. Is your firm able to obtain bonding in the amount required for the completion of this project?

Please provide a notarized declaration from the surety identified above, stating the amount of bonding capacity available to your firm for this project at Attachment F.

6. SAFETY

a. Does your firm have a written safety program compliant with current State regulations? It is not required to be attached.

b. Provide a list of key safety personnel, including the designated safety manager who will be assigned to this project, and list specific certifications. Points will be deducted if the safety manager does not have the minimum OSHA 30-hour certificate.

Name and Title Certifications (OSHA 30 minimum) c.

d.

b. Submit a letter from your insurance carrier listing your company’s Workmen’s Compensation Experience Modification Rate (EMR) for the most recent three-year policy period average. Include as Attachment H (1). Additionally, provide the EMR for the past five (5) years below:

2025 / 2024 / 2023 / 2022_________2021_

c. Provide the information requested below for the years shown using U.S. Bureau of Labor Statistics Guidelines to determine recordability and lost workdays from your firm’s

OSHA 300 logs.

Total Recordable Injury/Illness Case Rate:

2025: 2024: 2023 3-year average:

Lost Workday Case Rate:

2025: 2024: 2023: 3-year average:

e. Is your firm free of committing serious or willful violations of federal or state safety laws as determined by a final non-appealable decision of a court or government agency?

7. INSURANCE & CLAIMS HISTORY

xii. Is your firm free from any court judgments, pending litigation, arbitration and final agency decisions filed within the last five (5) years in a construction-related matter in which the contractor, or any officer, is or was party?

xiii. Has your firm during the past five (5) years been free of a determination by a court of competent jurisdiction that it filed a false claim with any Federal, State, or local government entity?

xiv. Does your firm have the ability to provide the required insurance in the limit stated in the project documents (General Liability and Comprehensive Auto at one million dollars ($1,000,000) per occurrence and at least one million dollars ($1,000,000) in the aggregate)? Attachment H (2) Letter or ACORD

8SCHEDULE- not applicable.

9 LABOR CODE VIOLATIONS

Has your firm, during the past five (5) years, been free of any determinations by a court or an administrative agency of repeated or willful violations of laws and/or regulations pertaining to the payment of prevailing wages or employment of apprentices of public works projects? Attachment J is not required to be submitted.

10 CLARIFICATIONS/EXPLANATIONS/ OTHER SUPPORTING MATERIAL (if necessary) (optional)

Please provide further explanation of items indicated requiring explanation, or other supporting material if necessary.

The undersigned certifies that all of the Qualification information submitted with this form is true and correct.

Name and Title Firm Name

Signature Address of Firm

E-mail Address City, State, Zip Code

Telephone

ATTACHMENTS INCLUDED:

(Please check all attachments included in this Submittal)

[ ] A Not required [ ] B Not required [ ] C Not required [ ] D Not required [ ] E Not required [ ] F Notarized Declaration From Surety

G H 1&2

Reserved Letter(s) From Insurance Carrier(s) for EMR and Ability to Insure

[ ] I Not required [ ] J Not required [ ] K Not required [ ] L Clarifications and Explanations/ Other Supporting Material (Optional)

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