22-Doc 00 45 13 - BIDDER QUALIFICATION STATEMENT - 2024.pdf

BIDDER QUALIFICATION STATEMENT

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DOCUMENT 00 45 13

1. INTRODUCTION

1.1 This document must be included as part of the Bid submission. Failure to submit a fully completed and executed Bidder Qualification Statement may be considered justification for rejection of the bid.

1.2 This Bidder Qualification Statement is submitted with respect to the following project:

Contract No: 2022-01256.01

Contract For: Montgomery Township – Whistlestop Park

2. GENERAL INFORMATION

2.1 Name of Bidder:

2.2 Address of Bidder:

2.3 Telephone No. of Bidder:

3. ORGANIZATIONAL BACKGROUND

3.1 Type of Organization:

Corporation Individual

Partnership Joint Venture

Other:

3.2 How long has your organization been in business

a. As a Contractor? years

b. As a Contractor engaged in construction work of the type proposed under this Contract:______ years

c. Under your current business name? ______ years

3.3 If the bidder is a corporation, complete this section:

a. Date & State of Incorporation:

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b. Names & Titles of Officers:

3.4 If the Bidder is other than a corporation, describe the structure of your organization including date of initiation as a business and list the principals involved:

3.5 What portions of the work (i.e. trades work items, etc.) included in the proposed contract will be performed by subcontractors?

4. WORK HISTORY

4.1 Attach or list the following information on similar projects which your organization has completed in the past five (5) years. Name and type of project, owner, engineer, contract amount, date of completion.

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4.2 Attach or list the following information on similar project which your organization now has in progress. Name and type of project, owner, engineer, contract amount, scheduled date of completion.

4.3 Has your organization ever defaulted on or otherwise failed to complete any work under contract? If so, note the circumstances:

4.4 Has any officer, partner or principal of your organization ever been an officer, partner or principal of another organization which defaulted on or otherwise failed to complete any work under contract? If so, note the circumstances:

4.5 Provide the construction experience (length, type) of the principal individuals of your organization which would be assigned to perform the proposed work under this Contract:

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4.6 Are there any actively filed claims resulting in pending litigation by any municipality? If so, provide the docket number(s) associated with the claim(s):

5. REFERENCES

5.1 Bonding Company

and Agent

5.2 Bank

5.3 Trade

6. FINANCIAL STATEMENT

6.1 Attach a copy of a recent financial statement as prepared by your auditor.

7. SAFETY RECORD

7.1 Attach a copy of your organization’s Health and Safety Plan.

7.2 Attach a copy of the most recent previous five years OSHA Log of Work-Related Injuries and Illnesses as prepared and certified by your organization.

7.3 Attach a copy of your Experience Modification Rate as prepared by your insurance company.

7.4 Has your organization been issued a stop work order pursuant to PA Title 34, Chapter

403 by the Pennsylvania Department of Labor and Industry, a municipal official, or a third-party enforcement agency due to unsafe building, structure, or equipment, and/or an unsafe incident or practice in the most recent prior five years? If so, note the circumstances:

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8. CERTIFICATION

8.1 This Bidder Qualification Statement has been prepared on behalf of the following organization:

Name of Organization:

Name of Preparer:

Title of Preparer:

Date:

8.2 AFFIDAVIT

State of , County of

I, , being duly sworn, according to (Name of Official) law, depose and say that I am the ___, (position) of the above organization, and that the responses provided in the Bidder Qualification

Statement, including any attachments thereto are true and correct to the best of my knowledge and belief.

Sworn and Subscribed _________________________ (Signature of Official) to before me this day of , 20 .

Notary Public

END OF DOCUMENT