21-Table 1 General Information.pdf

Table 1—General Information

Organization Name of Offeror

Form of Business:

☐ Joint Venture ☐ Corporation ☐ General Partnership ☐ Limited Partnership ☐ Individual Date Joint Venture / Incorporation / Partnership formed

State under which this organization was formed

Is this organization authorized to conduct business in the State of Texas: ☐ Yes ☐ No ☐ Pending List of companies, firms, or organizations that own any part of this organization.

Name of company, firm, or organization. Percent ownership

Provide information regarding the operational structure of the organization, including a list of officers, the limits of authority for these individuals with regards to the proposed Project, documentation of authority to execute documents, and authorization to conduct business in the State of Texas.

Corporate Office

Primary contact Main telephone number

Email address Website address

Business address of principal office

Regional Office

Primary contact Main telephone number

Email address Website address

Business address of regional office

Organization History List of names that this organization currently has or anticipates operating under over the history of the organization, including the names of related companies presently doing business:

Names of organization From date To date

Indicators of Organization Size Average number of current full time employees

Average estimate of revenue for the current year

Table 1—General Information Cont’d

Surety References Surety Name

Mailing address (principal place of business): Physical address (principal place of business):

Telephone (main number) Telephone (claims notices)

Name of Local Agent for Surety

Telephone Email

Surety is a corporation organized and existing under the laws of the state of:

Is surety authorized to provide surety bonds in the state of Texas? ☐ Yes ☐ No Is surety listed in “Companies Holding Certificates of Authority as Acceptable Sureties on Federal Bonds and as Acceptable Reinsuring Companies” as published in Circular 570 (amended) by the Financial Management Service, Surety Bond Branch, U.S. Department of the Treasury? ☐ Yes ☐ No Insurance Name of Insurance Provider

Provider is a corporation organized and existing under the laws of the state of:

Is Provider licensed or authorized to issue insurance policies in the State of Texas? ☐ Yes ☐ No

Does Provider have an A.M. Best Rating of A-VIII or Better? ☐ Yes ☐ No Mailing Address (principal place of business)

Physical Address (principal place of business)

Telephone (Main)

Telephone (for Notice of Claims)

Local Agent for Provider

Address for Local Agent

Telephone for Local Agent

Construction Site Safety Experience Provide Offeror's Experience Modification Ratio (EMR) for the last 3 years and the EMR history for the last 3 years of any proposed Subcontractor(s) that will provide Work valued at 25% or more of the Contract Price.

Provide documentation of the EMR history for Offeror and Subcontractor(s).

Offeror

Subcontractor Subcontractor Subcontractor

Year 1

Year 2

Table 1-General Information Cont’d Construction Site Safety Experience (Cont’d) Provide total number of any complaints or final orders by OSHRC against the Offeror and major Subcontractor for violation(s) of OSHA regulations within the last 3 years. For this category, major Subcontract is a Subcontractor that will provide Work valued at 10% or more of the Contract Price.

Year 3

Provide total number of any citations received by the Offeror or a major Subcontractor from any federal, state, or local environmental protection enforcement agency within the last 3 years. For this category, major Subcontract is a Subcontractor that will provide Work valued at 10% or more of the Contract Price.

Year 3

Provide Total Recordable Incident Rate (TRIR) for each year for the last 3 years for the Offeror and each proposed Subcontractor. For this category, major Subcontract is a Subcontractor that will provide Work valued at 10% or more of the Contract Price.

Year 3

Provide total number of fatalities for the last 10 years for the Offeror and each major Subcontractor. For this category, major Subcontract is a Subcontractor that will provide Work valued at 10% or more of the Contract Price.

Total

Table 1—General Information Cont’d Previous History with Owner List projects that have been completed with the Owner over the last 5 years. If more than 5 projects, list only the most recent.

Project Name Year

Previous Contracting Experience Years of experience in projects similar to the proposed project:

As a general contractor As a joint venture partner

Has this or a participating or a predecessor organization ever been disqualification as an offeror by any local, state, or federal agency within the last 5 years?

☐ Yes ☐ No If yes provide full details in a separate attachment.

Has this or a participating or a predecessor organization ever been barred from contracting by any local, state, or federal agency within the last 5 years?

☐ Yes ☐ No If yes provide full details in a separate attachment.

Has this or a participating or a predecessor organization been released from a bid or proposal in the past 5 years? ☐ Yes ☐ No If yes provide full details in a separate attachment.

Has this or a participating or a predecessor organization ever defaulted on a project or failed to complete any contract awarded to it?

☐ Yes ☐ No If yes provide full details in a separate attachment.

Has this or a participating or a predecessor organization ever refused to construct or refused to provide materials defined in the contract documents?

☐ Yes ☐ No If yes provide full details in a separate attachment.

Has this or a participating or a predecessor organization ever refused to provide materials or equipment defined in a change order?

☐ Yes ☐ No If yes provide full details in a separate attachment.

Is this or a participating or a predecessor organization currently involved in any litigation or contemplating litigation? ☐ Yes ☐ No If yes provide full details in a separate attachment.

Previous Claims History and Litigation Experience List all claims or litigation involving owners on other construction projects that have been active over the last 5 years or that are currently unresolved.

Claim Claim Status