11-Att 0.docx

The Offeror shall use this document ONLY and not substitute another format.

Submittals for this RFQ are accepted from single legal entities (e.g., corporation, partnership, sole proprietorship, limited liability company, limited liability partnership). The Offeror’s legal entity type, as identified in Attachment 0, must be in effect at the time of submittal (as documented in the Affidavit of Accuracy & Signature Page and accompanying documentation of signatory authorization) and shall be evident if awarded a contract from this competition.

Instructions: Provide the following information about the Offeror to this RFQ.

Date:

NAME OF OFFEROR

Offeror’s SBE/MBE/WBE Status (mark all applicable categories with an X):

Offeror’s Corporate Office Business Address and Telephone Number

Offeror’s Local Office Business Address and Telephone Number

Offeror’s contact person who can respond authoritatively to any questions about this submittal:

Name: ____________________________ Title: _____________________ Tel.: ______________

Email: _______________________________________________________________________________

Mailing Address: (if different than above) __________________________________________________

Type of organization (mark with an X):

1. Organization

A. How many years has Offeror been in business performing the work as described in this RFQ?

B. How many years has Offeror been in business under its present business name?

C. Under what other or former names has Offeror operated?

D. If Offeror is a corporation, please indicate:

Date of incorporation:

State of incorporation:

President’s name:

Vice-President’s name(s):

Secretary’s name:

Treasurer’s name:

Type of partnership (if applicable):

Name(s) of general partners:

Name of owner:

Name(s) of managing members:

H. If the form of Offeror is other than those listed above, describe it and name the principals:

I. Is the Offeror related to another entity as a parent, subsidiary or affiliate?

(Please indicate answer with an “X”)

Yes ( ) No ( )

If yes, give names and addresses of all affiliated parent and/or subsidiary companies. Indicate which companies are subsidiaries.

J. List the type of work the Offeror customarily performs with its own workforce.

K. List the type of work customarily subcontracted to others.

L. List of geographic area(s) in which the Offeror does business.

2. Judgments

A. Has the Offeror or any officer, director or owner thereof had any judgments entered against it/him/her within the past ten (10) years for breach of contracts for governmental or non-governmental work?

B. If yes, provide details on any such judgment.

3. Contract Compliance

A. Has Offeror been found to be in substantial noncompliance with the terms and conditions of any prior contract(s) with the City of Cincinnati or the City of Cincinnati acting as the sole management agency for the operation and maintenance of the Metropolitan Sewer District of Greater Cincinnati (MSDGC) on behalf of the County Commissioners of Hamilton County, Ohio?

B. If yes, provide details on any such instance.

C. Only answer the following question if Offeror has not contracted with MSDGC in the past five (5) years.

Has Offeror been found to be in substantial noncompliance with the terms and conditions of prior contracts with another public body without good cause?

Yes ( ) No ( )

D. If yes, provide details on any such instance.

4. Convictions

A. Has the Offeror or any officer, director or owner thereof been convicted within the past ten (10) years of a crime related to governmental or non-governmental construction or contracting?

B. If yes, provide details on any such conviction.

5. Debarment

A. Is the Offeror or any officer, director or owner thereof currently debarred pursuant to an established debarment procedure from bidding or contracting by any public body, agency of another state or agency of the federal government?

B. If yes, provide details.

6. Contract Execution History

A. Has the Offeror ever failed to enter into a contract in the past ten (10) years when the Offeror was the selected applicant?

Yes ( ) No ( )

B. If yes, give complete circumstances for each occurrence on a separate sheet(s) of paper.

Deviation of the submitted QQ from compliance with the Attachment 0 instructions and requirements may render the Offeror’s submittal as “non-responsive” by the City.

MSDGC QUALIFICATIONS QUESTIONNAIRE FOR RFQ # 265X901115

OWNER’S ADVISOR SERVICES FOR MILL CREEK WASTEWATER TREATMENT PLANT DEWATERING BUILDING IMPROVEMENTS

OFFEROR CORPORATE AND CONTACT INFORMATION (ATTACHMENT 0 TO RFQ)

MSDGC QUALIFICATIONS QUESTIONNAIRE FOR RFQ # 265X901115

OWNER’S ADVISOR SERVICES FOR MILL CREEK WASTEWATER TREATMENT PLANT DEWATERING BUILDING IMPROVEMENTS

OFFEROR CORPORATE AND CONTACT INFORMATION 0 TO RFQ)