10-Attachment D - Contractors Qualification Statement.docx

Instructions/Terms This Qualification Statement (“QS”) is required for proposals submitted for Construction Services for the Boulder Canyon Trail Repair Project BID-326-26. The QS shall be submitted to the County with your Proposal.

1. This QS shall be completed by a company officer or manager of the submitting firm who has sufficient knowledge to fully address all matters and respond to all inquiries herein.

2. The firm submitting this QS (“Firm” or the “Contractor”) shall be fully responsible for and bound by all information, data, certifications and disclosures included in this statement and any attachments hereto.

3. The Contractor understands that the information and data provided in connection with this QS, and any other relevant information obtained from any other sources regarding the Firm, shall be reviewed to determine whether it qualifies as a “responsible contractor” and whether its offer represents the best value to the County.

4. The Contractor understands that its failure to meet responsibility and qualification standards may render it ineligible to perform work on this project (hereinafter “Contract Work.”)

5. It is the Contractor’s responsibility to carefully review and complete this document. The failure to submit information or documents required by this QS, or the submission of any false statement, misrepresentation, or omission regarding a material fact concerning any aspect of this QS, may render the Firm ineligible for contract.

6. The Contractor hereby agrees that if it is awarded the contract, this QS, all terms and conditions specified herein, and all information, data, certifications and disclosures included in this statement or its attachments will be incorporated into the contract.

7. In the event a contract is awarded to the Firm and it is later determined that the Firm failed to disclose requested information, or made a false statement, misrepresentation, or omission regarding a material fact concerning any aspect of this QS, the Firm may be considered in default and the County may terminate the contract immediately and/or withhold full or partial payment as it deems appropriate.

8. Where additional space is needed to provide requested information, the Firm should provide such information in separate, numbered attachments affixed to this QS.

9. Label attachments to this QS according to subject matter and include a table of contents listing the names and numbers of all attachments.

Part I: Basic Qualifications Section 1: Firm Background/Resources

1. Name of Firm _________________________________________________________________

* Indicate whether the Firm is a corporation, joint venture, dba, limited liability company, partnership, sole proprietorship or other type of business entity. If corporation, provide names of officers; if joint venture, provide names of joint ventures; if limited liability co., provide names of members; if partnership, provide names of partners; if sole proprietorship or other, provide names of owners.

2. Address/Contact Information: _____________________________________________________ ______________________________________________________________________________ *Provide mailing address of Firm, website, e-mail, telephone number and fax number. If address is a branch office, also provide principal home office address.

3. Years in Business: ____________

4. Related Firms/Changes in Company Name: ___________________________________________ *Identify any parent companies, subsidiaries, sister companies or holding companies to which the firm is related. If additional space is needed, provide information in an attachment. If the Firm has previously operated under another name within the past five years, identify other names used.

5. Identify all jurisdictions in which the Firm is licensed, registered or otherwise qualified to do business:_______________________________________________________________________ ________________________________________________________________________ *Use attachment if necessary, provide applicable license, certificate, registration numbers for each jurisdiction.

6. Percentage of Work Self-Performed: Identify the percentage of work the Firm typically performs with its own workforce: ______________

7. Classifications of Work Self-Performed: Identify the types of work typically performed by the Firm with its own workforce:

8. Provide Firm’s organizational chart, if available.

9. Identify and submit resumes for members of the construction team for this project.

10. Identify and submit company name, contact person, address, telephone number, and three references for all companies that will provide services to the Firm for this project.

Section 2: Required Disclosures The Contractor submitting this QS shall answer the following questions with regard to the past five (5) years. If any question is answered in the affirmative, the Firm shall submit an attachment, providing details concerning the matter in question, including applicable dates, locations, names of projects/project owners and circumstances.

1. Has the Firm been debarred, suspended or otherwise prohibited from doing business with any federal, state or local government agency, or private enterprise?

Yes ___ No ___

2. Has the Firm been denied prequalification, declared non-responsible, or otherwise declared ineligible to submit bids or proposals for work by any federal, state or local government agency, or private enterprise?

Yes ___ No ___

3. Has the Firm defaulted, been terminated for cause, or otherwise failed to complete any project that it was awarded?

Yes ___ No ___

4. Has the Firm been assessed or required to pay liquidated damages in connection with work performed on any project?

Yes ___ No ___

5. Has the Firm had any business or professional license, registration, certificate or certification suspended or revoked?

Yes ___ No ___

6. Have any liens been filed against the Firm as a result of its failure to pay subcontractors, suppliers, or workers?

Yes ___ No ___

7. Has the Firm been denied bonding or insurance coverage, or been discontinued by a surety or insurance company?

Yes ___ No ___

8. Has the Firm been found in violation of any laws, including but not limited to contracting or antitrust laws, tax or licensing laws, labor or employment laws, environmental, health or safety laws?

Yes ___ No ___ *With respect to workplace safety laws, this statement is limited to willful federal or state safety law violations.

9. Has the Firm or its owners, officers, directors or managers been the subject of any criminal indictment or criminal investigation concerning any aspect of the Firm’s business?

Yes ___ No ___

10. Has the Firm been the subject to any bankruptcy proceeding?

Yes ___ No ___

Part II: Past Performance Review Section 1: Project Listings & Past Performance Data

1. The Contractor shall submit three projects that are similar in size, scope and complexity to the Contract Work, public or private, it has performed in the last five years in an attachment labeled “Past Projects.”

2. List projects in reverse chronological order, beginning with most recent. For each project listed, the Contractor shall provide the following information.

a. The name, location and project number of the project.

b. The names, addresses and phone numbers of at least two owner representatives familiar with the Contractor’s performance on the project (may include owners, project managers, architects, engineers).

c. The original date for schedule completion and actual completion date.

d. Any performance ratings given to the Contractor (whether descriptive, e.g., good, satisfactory, or numerical, e.g., 80 out of 100, or other).

3. The Contractor shall submit a complete list of all open or on-going projects, public and private, in an attachment labeled “Current Projects.” List projects in reverse chronological order, beginning with the most recent. For each project listed, provide the following information.

a. The name, location and project number of the project and percentage of work completed to date.

b. The names, addresses and phone numbers of at least two owner representatives familiar with the Contractor’s performance on the project (may include owners, project managers, architects, engineers).

c. The original date for schedule completion and estimated completion date.

Section 2: Pending Legal Matters

1. Claims, Judgments, Lawsuits: Are there any pending claims, judgments, lawsuits or alternative dispute proceedings involving the Firm that involve potential damages of $10,000 or more?

____ Yes ____ No If yes, provide details in an attachment.

2. Complaints, Charges, Investigations: Is the Firm currently the subject of any complaint, investigation or other legal action for alleged violations of law pending before any court or governmental agency?

___ Yes ____No If yes, provide details in an attachment.

Part III: Required Representations In submitting this QS, the Firm makes the following representations, which it understands are required as a condition of performing the Contract Work and receiving payment for same.

1. The Firm will possess all applicable professional and business licenses required for performing work in Boulder County.

2. The Firm satisfies all bonding and insurance requirements as stipulated in the solicitation for this project.

3. The Firm and all subcontractors that are employed or that may be employed in execution of the Contract Work shall be in full compliance with Boulder County’s requirements for workers’ compensation insurance.

4. The Firm represents that it has no conflicts of interests with Boulder County if awarded the Contract Work and that any potential conflicts of interest that may arise in the future will be disclosed immediately to Boulder County.

5. The Firm represents the price offered and other information submitted in connection with its proposal for the Contract Work were arrived at independently without consultation, communication or agreement with any other offeror or competitor.

6. The Firm will ensure that employees and applicants for employment are not discriminated against because of their race, color, religion, sex or national origin.

The undersigned hereby represents that all statements, representations, information and documents provided in or with this Qualification Statement and attachments hereto are complete, accurate and truthful.

Firm Name