2-AmphCommCntrPh4-CQS.pdf

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THE ASSOCIATED GENERAL CONTRACTORS OF AMERICA

CONSTRUCTION CONTRACTOR’S QUALIFICATION STATEMENT

FOR ENGINEERED CONSTRUCTION

AGC of America developed this qualification statement in cooperation with the Engineers Joint Contract Documents Committee (EJCDC), which recommends its use as a suggested generic prequalification statement or a contract-specific qualification statement. The owner or engineer may wish to make appropriate supplemental inquiries in the latter case.

The Engineers Joint Contract Documents Committee consists of representatives of the following organizations:

National Society of Professional Engineers American Consulting Engineers Council

American Society of Civil Engineers Construction Specifications Institute

The contents of this statement are CONFIDENTIAL.

Submitted by:

Name of Organization

Name of Individual

Title

Address

Telephone

Submitted to:

Name Freemansburg Borough

Address 600 Monroe Street, Freemansburg, PA 18017

Telephone 610-866-2220

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Project Name and Description (if applicable):

Amphitheater / Community Center – Phase 4:

Design & construction of cast-in-place concrete retaining walls and concrete footings;

and all associated work as specified in this project manual. Any and all geotechnical investigation necessary for the design of the walls.

1. Contractor’s General Business Information

Check If:

Corporation Partnership Joint Venture Sole Proprietorship

If Corporation:

a. Date and State of Incorporation

b. List of Executive Officers

Name Title

If partnership:

a. Date and State of Organization

b. Names of Current General Partners

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c. Type of Partnership

General Limited Publicly Traded Other (describe):

If Joint Venture:

b. Name, Address, and Form of Organization of Joint Venture Partners:

(Indicate managing partner by an asterisk *)

If Sole Proprietorship:

b. Name and Address of Owner or Owners

2. On Schedule A, attached, list major engineered construction projects completed by this organization in the past five (5) years. (If joint venture, list each participant’s projects separately.)

Schedule B, attached, lists current projects under construction by this organization. (If joint venture, list each participant’s projects separately.)

3. Name of Surety Company and agent’s name, address, and phone number.

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4. Is your organization a member of a controlled group of corporations as defined in I.R.C. Sec.

1563?

Yes No

If yes, show the names and addresses of affiliated companies.

5. Furnish on Schedule C, attached, details of the construction experience of the principal individuals of your organization directly involved in construction operations.

6. Has your organization ever failed to complete any construction contract awarded to it?

If yes, describe the circumstances in the attachment.

7. Has any Corporate officer, partner, joint venture participant, or proprietor ever failed to complete a construction contract awarded to them in their name or when acting as a principal of another organization?

8. In the last five (5) years, has your organization failed to complete a project on time substantially?

9. Indicate general types of work performed with your workforce.

10. What is your approximate total bonding capacity?

$500,000 to $2,000,000 $2,000,000 to $5,000,000 $5,000,000 to $10,000,000 $10,000,000 or more

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11. Furnish the following information concerning an accredited banking institution familiar with your organization.

Name of Bank

Address

Account Manager

Telephone

I, at this moment, certify that the information submitted herewith, including any attachments, is accurate to the best of my knowledge and belief.

(Name of Person Authorized to Sign)

By:

(Signature)

Title:

Dated:

Subscribed and sworn to before me this ____ day of ____________, 20___.

Notary Public:

My Commission Expires:

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SCHEDULE A

Name, Location and Description of Project Owner Design

Engineer Date

Completed Contract Price Reference/Contact Include Address and Phase

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SCHEDULE B

Name, Location and Description of Project Owner Design

Engineer Contract Price Amount Completed

Date of Scheduled

Completion

Reference/Contact Include Address & Phone

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SCHEDULE C

Name Position Date Started with this Organization

Date Started in Construction

Prior Positions and Experience in Construction