15-EXHIBIT N- Proposal Questionnaire.pdf

EXHIBIT N

TOWN OF HILTON HEAD ISLAND

PROPOSAL for CONSTRUCTION SERVICES

RFP 2025-30

Stormwater Maintenance & Repair Services

NOTE: In order for the Proposal to be considered, it is necessary for an authorized individual of the firm, and on behalf of the firm, to furnish the information requested below.

Date Prepared:

Submitted To: Town of Hilton Head Island

One Town Center Court, Hilton Head Island, SC 29928.

Submitted By:

(Complete Firm Name: Must be the same as the name that will appear on Proposals)

(Complete Street Address and Suite Number, if applicable)

(P. O. Box Number, if applicable) (Zip Code for P. O. Box Number)

(City) (County) (State) (Zip Code for Street Address)

Telephone Number: (______)

Fax Number: (______)

Web Site Address:

E-mail Address:

Federal Employer Identification Number:

South Carolina General Contractor Information:

License Number:

License Type:

Classification(s):

Stormwater Maintenance & Repair Services Proposal Questionnaire

EXHIBIT N

PROPOSAL QUESTIONNAIRE

RFP 2025-30

Stormwater Maintenance & Repair Services

1. Indicate below the experience of the Personnel to be assigned to this Contract; Key Personnel include the Officer in Charge, Designated Representative, and Job Superintendent/Project Manager. Please specify if one person will fulfill more than one key role. Key Personnel shall have experience and knowledge of these disciplines: general flatwork construction, stormwater pipe installation and repair, grading, concrete structures, and concrete and asphaltic paving. In addition to this form, please include resumes for all Key Personnel assigned to this Contract. Please ensure enough personnel are listed below to verify your company is capable of working on multiple projects simultaneously.

Personnel

Position on this Contract Individual's Name

Years Employed

By The Firm

Total Years of Experience

Drainage Grading Concrete Paving

*Officer in Charge

Office Manager

*Designated Representative

*Project Manager(s)/ Superintendent(s)

Estimator

Foreman (Pipe)

Foreman (Earthwork)

Foreman (Concrete)

Foreman (Paving)

Equipment Operator(s)

Laborer(s)

*Designates Key Personnel that must submit resumes

2. Name of Designated Representative for this Contract: _______________________________ Office Address: _____________________________________________________________ Office Number: (______) _______________ Mobile: (______) _______________________ E-Mail: ___________________________________________________________________ Total Workload Availability of Designated Representative for this Contract: ___________% Years of Experience Working in Stormwater/Wet Utility Construction: ___________ Years of Experience as a Construction Project Manager: ___________ *The Designated Representative will be the only point of contact between the Contractor and the Town, and must have sufficient availability to meet onsite and correspond as necessary for the duration of this Contract. The Designated Representative will submit all invoices and supporting documentation. They will also be responsible for scoping projects, executing Job Orders, resolving all conflicts with paperwork and field work, and answering any questions the Town may have. If the Designated Representative changes, the Town must be notified in writing.

3. Provide a list of Subcontractors intended to be used for this Contract. The Town is aware that the Subcontractors may change throughout the course of the Contract. Please be aware that all Subcontractors utilized for this Contract must be approved in writing by the Town prior to utilization.

continued on next page

Contract Subcontractors

Company Name, Phone Number, Email

Trade / Specialty Office Address

Years in Business under this name

Number of Projects worked on together

4. List at least 10 similar projects (i.e. stormwater maintenance, repair, construction, etc.) the firm has completed in the past 5 years, as a Primary Contractor only. Similar stormwater construction projects that were completed by the Contractor acting as the Subcontractor can be listed, but must be in addition to the 10 minimum projects required to be listed as the Contractor acting as the Primary Contractor. Please designate which projects were completed by the Contractor as either the Primary or Subcontractor. If the Contractor has done any similar work for the Town, the project(s) must be listed below with the current contact.

Similar Stormwater Work Experience Contract Owner, Company Name, Current Contact Name, Phone Number, and E-mail

Contract Amount

Date Completed/

Term of Contract

Primary or

Subcontractor (P/S)

Name of Project / Type of Construction Work / Description of Project/ Key Personnel Involved

1.)

2.)

3.)

4.)

5.)

6.)

7.)

8.)

9.)

10.)

5. How many years has the firm been in business under the present name?

6. How is the firm presently organized? (i.e. Corporation, Company, Partnership, Sole

Proprietorship, etc.)

7. Date of Organization:

8. Organized under the Laws of which State?

9. Date Commenced Business:

10. If the firm is a corporation, is it registered with the Secretary of State, to do business in South

Carolina? _______(Y/N). If yes, give date of Certificate of Existence or Authority.

11. If the firm is a corporation not organized under the laws of South Carolina, provide the complete name and address of its Registered Agent in South Carolina.

12. List the present officers of the firm and their titles:

13. Has any officer or partner of the firm ever been an officer or partner of some other firm that failed to complete a construction contract? _______ (Y/N). If yes, give name of individual, other firm, and name of owner of project, location, type of project, and the reason for the failure to complete such project.

14. Has the firm, its parent or subsidiary, including owners, corporate officers or stockholders, either collectively or individually, ever been suspended, disqualified, or debarred from doing business with any Municipality, State or the Federal Government? ______(Y/N). If yes, provide complete details, including the agency and relevant circumstance - when, where and why.

15. Have you or any officer, partner, or employee(s) of the firm been suspended, disqualified, or debarred from doing business by South Carolina, or any other State or the Federal Government? __________ (Y/N). If yes, provide complete details, including the agency and relevant circumstance - when, where and why.

16. Have you or any of the individuals or entities referred to above, in the past six years, been indicted, pled guilty, pled nolo contendere, or been convicted of any antitrust violation for any act prohibited by State or Federal law committed in any jurisdiction in the United States involving fraud, collusion, conspiracy with respect to bidding on public contracts?

____________(Y/N). If yes, give complete details.

17. Have you or any of the individuals or entities referred to above, in the past six years, been indicted, pled guilty, pled nolo contendere, or been convicted of embezzlement, theft, forgery, bribery, receiving stolen property, or any other offense indicating a lack of business integrity, or business honesty which seriously and directly affects the question of present responsibility as a contractor in any jurisdiction in the United States? __________(Y/N). If yes, give complete details.

18. Are you under the protection of any Bankruptcy Court, or does the firm have pending any

Petition in any Bankruptcy Court, or has there been an assignment for the benefit of any creditors? __________ (Y/N). If yes, give complete details.

19. Has the firm, its subsidiaries, affiliates or parent companies ever defaulted on a contract with any Local, State or Federal Government? ________ (Y/N). If yes, give complete details.

20. List any Officers, Directors, Bid Estimators and any other individual(s) and their position, which are authorized to submit bids on behalf of the firm.

21. List the firm's subsidiaries, affiliates and parent companies.

22. Provide the names of the individuals or companies which have a financial interest of at least five (5%) percent in the firm, and reflect the amount of that interest of each. If another company owns the firm, list its officers and directors.

23. Name of Surety Company:

Surety Address:

Agency Name:

Agency Address:

City: State: Zip Code:

Agency Phone Number: (__________)

24. Provide a list of the operational equipment (i.e. make, model, operating weight, volume/capacity) possessed by the firm (both owned and leased) to be utilized in this Contract (e.g. Excavators, bush hog, pumps, trailers, trucks, dump trucks and capacity, skid steers, etc.).

25. The individuals listed below are authorized to approve, sign and/or execute on the firm’s behalf, the following documents:

Document Code No.: 1 - Organization's Statement of Experience and Equipment.

2 - Proposals, Contracts and Bonds.

3 - Change Order(s)/Supplemental Agreement(s) 4 - Force Account Agreement(s) 5 – Job Order(s) [Designated Representative must be authorized to sign]

NAME

TITLE DOCUMENT

CODE NO.

If any changes are made to the list above after the preparation date of this Proposal Questionnaire, it SHALL be the sole responsibility of the Contractor to submit another original updated Certified document, advising of such changes, to the office to which this Proposal Questionnaire was submitted.

AFFIDAVIT

______________________________ BEING DULY SWORN DEPOSES AND SAYS

THAT HE/SHE IS AUTHORIZED TO EXECUTE THIS AFFIDAVIT FOR AND ON

BEHALF OF THE APPLICANT FIRM, AND THE ANSWERS TO THE FOREGOING

QUESTIONS AND ALL STATEMENTS HEREIN CONTAINED ARE TRUE AND

CORRECT TO THE BEST OF HIS/HER KNOWLDEDGE.

Sworn and subscribed to before ______________________________ me on this ______ day of (Name of Applicant)

(Authorized Signature)

(Notary Public) (Print or Type Name) (Not an Officer of the firm) (Title)

AFFIX

CORPORATE

SEAL

HERE

NOTICE: THE TOWN MUST BE NOTIFIED OF ANY SIGNIFCANT CHANGE IN THE

INFORMATION FURNISHED IN THIS QUESTIONNAIRE WITHIN FIFTEEN (15) DAYS

OF THE OCCURRENCE OF SUCH CHANGE.