2.Attachment A-dgs-30-168_08-20_co-16.docx

DGS-30-168 CO-16

(Rev. 08/20)

ATTACHMENT A

COMMONWEALTH OF VIRGINIA

STANDARD FORM

FOR

CONTRACTOR'S

STATEMENT OF QUALIFICATIONS

July 24, 2026

TO BE COMPLETED BY BIDDERS OR OFFERORS IN RESPONSE TO THE RFQ AND THE QUALIFICATION CRITERIA PROVIDED THEREIN;

COMPLETE ALL INFORMATION TO BE CONSIDERED RESPONSIVE

Submissions missing required information will not be forwarded to the Committee for review per RFP Section 2; Submission Requirements, Item D

BE SURE TO TAKE NOTE OF ALL BLUE BOLDED AND UNDERLINED TEXT

TABLE of CONTENTS

CONTRACTOR'S STATEMENT OF QUALIFICATIONS

I. General Information

1. Submitted to (Agency) and Address:

Commonwealth of Virginia; Virginia State University Physical Plant Building; Capital Outlay Department 2916 Myster Macklin Street, Suite 30A Petersburg, Virginia 23806

2. Name of Project and Project Code Number PC#:

3. Type of work you wish to qualify for:

Selected Historic Renovations Campuswide

4. Contractor's Name:

Mailing Address:

Street Address: (If not the same as mailing address)

Telephone Number: (…) Contact Person:

Contact Person’s Phone Number: (…) State Contractor's License Number:

Designated Employee Registered with the Virginia Board for Contractors:

Provide the name and title, direct telephone number (including extension), cellular telephone number and direct e-mail address of the highest ranking individual within the organization that will have oversight responsibility for the organization's involvement with the Project (if not the designated contact person above):

If different from the location provided above, provide the organization's local or regional office information (including physical address, mailing address, telephone number, and main e-mail address) to be used in delivering the requested services to be provided on the Project:

Provide the number of years that the organization has been providing services similar to those requested by this RFQ, including a delineation of this information for both the headquarters location and the local or regional office (as appropriate) that will be used in delivering the requested services on the Project:

5. Check type of organization:

Corporation Partnership

Individual Joint Venture

Other (describe)

If the Proposal is being made by a legal joint venture, the response must include the information required within this section of the Form CO-16 for both organizations that constitute the joint venture and a copy of the joint venture agreement must be attached:

6. If a corporation:

State of Incorporation:

Date of Incorporation:

Federal I.D. #:

Are you a Subchapter S Corporation? Yes ___ No ___

Officers Name Years in Position

Chief Executive Officer:

Chief Financial Officer:

President:

Vice President Secretary Treasurer Office Manager of local office that will have primary responsibility for delivering this project:

7. If a partnership:

Date organized:

Type of partnership:

List of General Partners:

Name Phone # Years as G.P.

8. If individually owned:

Years in Business:

9. Have you ever operated under another name? Yes___ No ___ If yes:

Other name:

Number of years in business under this name:

State license number under this name:

10. Department of Small Business and Supplier Diversity (DSBSD) Certifications:

Check all that apply:

ADD the DSBSD Certification Number:

Check if this applies:

NON-DSBSD CERTIFIED BUSINESS (LARGE): ( ) YES

II. Bonding

Provide a letter from your surety company listing your organization’s current single Project and total Projects bonding capacity, including such information for the local or regional office that will be used in delivering the services to be provided on the Project (if the local or regional office is separately bonded); include this letter with your Form CO-16 submission. For projects that are applying for bonding under the Self-Bonding Program, contact Owner for submission requirements.

1. Bonding Company's name:

Representative (Attorney-in-fact):

Address:

2. Is the Bonding Company listed on the United States Department of the Treasury list of acceptable surety corporations?

Yes___ No ___

3. Is the Bonding Company licensed to transact surety business in the Commonwealth of Virginia?

Yes___ No ___

4. Describe the capacity the organization to meet the project schedule and demands. Include an analysis of current workload.

III. Judgments

In the last ten (10) years, has your organization, or any officer, director, partner or owner, had judgments entered against it or them for the breach of contracts for construction?

Yes___ No ___

If yes, on a separate attachment, state the person or entity against whom the judgment was entered, give the location and date of the judgment, describe the project involved, and explain the circumstances relating to the judgment, including the names, addresses and phone numbers of persons who might be contacted for additional information.

IV. Convictions and Debarment If you answer yes to any of the following, on a separate attachment, state the person or entity against whom the conviction or debarment was entered, give the location and date of the conviction or debarment, describe the project involved, and explain the circumstances relating to the conviction or debarment, including the names, addresses and phone numbers of persons who might be contacted for additional information.

1. In the last ten (10) years, has your organization or any officer, director, partner, owner, project manager, procurement manager or chief financial officer of your organization:

A. Ever been fined or adjudicated of having failed to abate a citation for building code violations by a court or local building code appeals board?

Yes___ No ___

B. Ever been found guilty on charges relating to conflicts of interest? Yes___ No ___

C. Ever been convicted on criminal charges relating to contracting, construction, bidding, bid rigging or bribery?

Yes___ No ___

D. Ever been convicted: (i) under Va. Code Section 2.2-4367 et seq. (Ethics in Public Contracting); (ii) under Va. Code Section 18.2-498.1 et seq. (Va. Governmental Frauds Act); (iii) under Va. Code Section 59.1-68.8 et seq. (Conspiracy to Rig Bids); (iv) of a criminal violation of Va. Code Section 40.1-49.4 (enforcement of occupational safety and health standards); or (v) of violating any substantially similar federal law or law of another state?

Yes___ No ___

E. Ever been convicted on charges relating to employment of illegal aliens on construction projects?

Yes___ No ___

V. Compliance

If you answer yes to any of the following, on a separate attachment give the date of the termination order, or payment, describe the project involved, and explain the circumstances relating to same, including the names, addresses and phone numbers of persons who might be contacted for additional information.

1. Has your organization:

A. Ever been terminated on a contract for cause? Yes___ No ___

B. Within the last five (5) years, made payment of actual and/or liquidated damages for failure to complete a project by the contracted date?

Yes___ No ___

2. Has your organization, in the last three (3) years, received a final order for willful and/or repeated violation(s) for failure to abate issued by the United States Occupational Safety and Health Administration or by the Virginia Department of Labor and Industry or any other government agency?

Yes___ No ___

3. Have any Performance or Payment Bond claims ever been paid by any surety on behalf of your organization?

Yes___ No ___

4. Has your organization been more than thirty (30) days late, without good cause, in achieving the contracted substantial completion date where there was no liquidated damages provision on more than two (2) projects in the last three (3) years?

Yes___ No ___

5. Has your organization finally completed a project more than ninety (90) days after achieving substantial completion on two (2) or more projects in the last three (3) years, for reasons within the contractor’s control? Documented delay of delivery of material necessary to perform remaining work or seasonal conditions that bear on performing the work or operating specific equipment or building systems shall be considered in litigation.

Yes___ No ___

6. Has your organization received more than two (2) cure notices on a single project in the past two (2) years and/or more than one (1) cure notice on five (5) separate projects in the past five (5) years?

Yes___ No ___

7. Has your organization had repeated instances on a project of installation and workmanship deviations which exceed the tolerances of the standards referenced in the contract documents? Documentation of such instances shall be the written reports and records of the Owner’s representatives on the project.

If your organization has multiple offices, provide the following information for the office that would handle projects under this prequalification. If that office has limited history, list its experience first.

1. Provide as a separate attachment, a list of all projects providing project name, location, size, dollar value, and completion date for each that your organization has completed in the last ten (10) years; include years 2026 to 2016.

Details for layout of list:

A. Provide as a separate attachment B. Include the year at the top of the page C. List all the projects for each year

2. Provide as a separate attachment, a list of your organization's projects in progress, if any, at the time of this statement. At a minimum, provide project names and addresses, contract amounts, percentages complete and contact names and numbers for the architects and owners.

Details for layout of list:

A. Provide as a separate attachment B. Include the year at the top of the page C. List all the projects for each year

3. Identify three (3) projects from those identified in 1 and 2 above which are most relevant or similar to the project(s) for which you are seeking prequalification; these projects are designated as your “Firm’s Representative Projects”.

A. Provide detailed information for Similar Job 1, 2, and 3 as listed below B. Expand sheet as necessary to provide all the data that is requested C. Respond with detail to be responsive D. Complete all sections and fill in the all blanks; do not use the words N/A or TBD or “reference attachment”. All data shall be included on these forms.

E. Agency will conduct reference checks.

F. Project pictures are acceptable and encouraged. A blank space has been added at the end of each Similar Job to attach pictures.

SIMILAR JOB 1:

Project Name:

Owner's Name:

Address:

Architect's Name:

Address:

List Project Delivery Method:

Such as: design/bid/build, Prequalification, CM@Risk, or Design/Build

Residential or Commercial:

Project Cost:

List Key Personnel:

List Project Similarities:

EXPERIENCE AND PERFORMANCE ON PROJECTS OF SIMILAR SIZE AND SCOPE

Firm and Key Personal Experience; mark yes or no for each question:

1. Project was 4,000- 60,000 GSF and built prior to 1971: Yes___ No ___

2. Project was a Minimum of two stories: Yes___ No ___

3. Project was a Brick structure with period millwork, carpentry and fenestrations: Yes___ No ___

4. Project was Residential prior to 1930, such as apartment building, residential dormitory, single-family residence or similar within a historic district, area or place: Yes___ No ___

5. Project was an exterior renovation involving period work, especially millwork, window, and door work: Yes___ No ___

6. Project was an interior renovation involving hydraulic elevators, construction of a new egress corridors and storefront entrances: Yes___ No ___

7. Project was on or eligible for listing on the National Register of Historic Places: Yes___ No ___

8. Project was located in an occupied building: Yes___ No ___

9. Project was in an active location on the campus, requiring coordination and maintenance of continuous access to campus points of interest and pedestrian and vehicular paths: Yes___ No ___

10. Project was delivered within budget and on time: Yes___ No ___

11. Project did not result in unplanned disruptions: Yes___ No ___

12. Project required coordination of state and special inspections: Yes___ No ___

Further details on description of the work performed on the project that is not listed above:

Describe key lessons learned; Lessons learned should be different for each project:

List ALL change orders:

How many total:

Owner requested:

Contractor requested:

Provide the percentage complete if project is current OR substantial and final completion dates:

Were there any schedule impacts? Or any unplanned disruptions? If yes, please provide detail. If no, please write “none”:

During the One Year GC Warranty, explain the Contractor maintenance and repair support that was provided to the Agency; only write N/A if the project is still in progress:

Add Project pictures here

SIMILAR JOB 2:

Project Name:

Owner's Name:

Address:

Architect's Name:

Address:

List Project Delivery Method:

Such as: design/bid/build, Prequalification, CM@Risk, or Design/Build

Residential or Commercial:

Project Cost:

List Key Personnel:

List Project Similarities:

1. Project was 4,000- 60,000 GSF and built prior to 1971: Yes___ No ___

2. Project was a Minimum of two stories: Yes___ No ___

3. Project was a Brick structure with period millwork, carpentry and fenestrations: Yes___ No ___

4. Project was Residential prior to 1930, such as apartment building, residential dormitory, single-family residence or similar within a historic district, area or place: Yes___ No ___

5. Project was an exterior renovation involving period work, especially millwork, window, and door work: Yes___ No ___

6. Project was an interior renovation involving hydraulic elevators, construction of a new egress corridors and storefront entrances: Yes___ No ___

7. Project was on or eligible for listing on the National Register of Historic Places: Yes___ No ___

8. Project was located in an occupied building: Yes___ No ___

9. Project was in an active location on the campus, requiring coordination and maintenance of continuous access to campus points of interest and pedestrian and vehicular paths: Yes___ No ___

10. Project was delivered within budget and on time: Yes___ No ___

How many total:

Owner requested:

Contractor requested:

Provide the percentage complete if project is current OR substantial and final completion dates:

Were there any schedule impacts? Or any unplanned disruptions? If yes, please provide detail. If no, please write “none”:

During the One Year GC Warranty, explain the Contractor maintenance and repair support that was provided to the Agency; only write N/A if the project is still in progress:

SIMILAR JOB 3:

Project Name:

Owner's Name:

Address:

Architect's Name:

Address:

List Project Delivery Method:

Such as: design/bid/build, Prequalification, CM@Risk, or Design/Build

Residential or Commercial:

Project Cost:

List Key Personnel:

List Project Similarities:

1. Project was 4,000- 60,000 GSF and built prior to 1971: Yes___ No ___

2. Project was a Minimum of two stories: Yes___ No ___

3. Project was a Brick structure with period millwork, carpentry and fenestrations: Yes___ No ___

4. Project was Residential prior to 1930, such as apartment building, residential dormitory, single-family residence or similar within a historic district, area or place: Yes___ No ___

5. Project was an exterior renovation involving period work, especially millwork, window, and door work: Yes___ No ___

6. Project was an interior renovation involving hydraulic elevators, construction of a new egress corridors and storefront entrances: Yes___ No ___

7. Project was on or eligible for listing on the National Register of Historic Places: Yes___ No ___

8. Project was located in an occupied building: Yes___ No ___

9. Project was in an active location on the campus, requiring coordination and maintenance of continuous access to campus points of interest and pedestrian and vehicular paths: Yes___ No ___

10. Project was delivered within budget and on time: Yes___ No ___

How many total:

Owner requested:

Contractor requested:

Provide the percentage complete if project is current OR substantial and final completion dates:

Were there any schedule impacts? Or any unplanned disruptions? If yes, please provide detail. If no, please write “none”:

During the One Year GC Warranty, explain the Contractor maintenance and repair support that was provided to the Agency; only write N/A if the project is still in progress:

4. Staffing: Describe how your firm would staff this project.

A. The Proposal must include a description of the duties and responsibilities of all key Project team members.

TO MAKE IT EASY ON THE COMMITTEE, DO NOT PROVIDE AS A SEPARATE ATTACHMENT, PROVIDE THIS INFORMATION BELOW (expand as necessary). The personnel resumes will not replace this information below:

B. The Proposal must include, as a separate attachment, an organizational chart indicating the title or function of each individual and the reporting structure and functional relationships between the team members.

5. Personnel experience: For all designated key personnel (i.e: project manager, superintendent, etc.), describe the background and experience that would qualify him or her to serve successfully on this project. The Proposal must include, as separate attachments, a resume for all key personnel to be assigned to this project. Resume to include:

A. Title (Principal, Project Manager, Superintendent, etc.).

B. Number of years of experience in the construction industry.

C. Summary of education, including the name(s) of the institution(s) from which the individual graduated and the year(s) of graduation.

D. Listing of professional registrations, including registration numbers and dates that the respective registrations were first obtained and provide any trade organization affiliations in which the individual actively participates.

E. Identify at least three (3) similar or comparable projects on which each proposed key personnel have served in that capacity or positions of similar or comparable responsibility within the last ten (10) years, including at least one of those within the last five years.

For these three (3) projects, if the project is NOT a “Firm Representative Project” listed above, then provide the names, addresses, and phone numbers of the Owner’s and Architect’s contact person for each that can be contacted to obtain an assessment of the individual’s competencies and capabilities for the project.

For these three (3) projects, attach as a separate document using the format of the “Similar Job” listed above.

6. Provide additional attachments, as required, in response to any additional agency-specified prequalification criteria provided in the RFQ.

A. Attachment C requires to the Contractor to indicate roofing types for which the firm is qualified to provide maintenance and repair.

B. Attachment D requires the Contractor to identify warranty work the firm can currently provide by manufacturer and material type.

VIII. Signatures

The undersigned certifies under oath that the information contained in this Statement of Qualifications and attachments hereto is complete, true and correct as of the date of this Statement.

(Name of entity signing this Statement of Qualifications)

By: Name of Signer (print)

(Signature in ink)

Title:

Date:

Notary

State of:

County/City of:

Subscribed and sworn to before me this day of , 2024

Notary Public Signature

My commission expires:

Notary Seal:

Attachments (to be provided):

1. RFQ signature pages

2. Attachment A; DGS-30-168_04-15_CO-16; Completed form

3. Attachment B; SCC form; Completed SCC form

4. Additional information, provided under CO-16 Sections II, III, IV, V, VI

5. Any issued addendums; return signature page acknowledging the addendum