26-0069 Attachment D- Contractor Information Form (1).PDF
PDF 490 KB Posted
- Solicitation number
- RFP-DET-250000002601-3
- Issued by
- Wayne County, Detroit City, Michigan
About this file
The document is a Contractor Information Form (Appendix A) related to a potential contract opportunity, likely with Gilbane Building Company. The form is a comprehensive template designed to collect detailed information about a potential contractor, including business history, financial status, licensing, experience, safety record, and references. The form requests information spanning several key areas: years in business, business structure, annual gross sales for the past three years, federal and D-U-N-S numbers, state licenses, project experience, and critical operational history.
The form seeks to evaluate a contractor's qualifications through detailed inquiries about past performance, including any instances of failed project completions, removals from awarded work, bankruptcy filings, bonding history, pending legal actions, and safety violations. Additional sections require disclosure of subcontractor involvement, workman's compensation experience modification rating, and references from comparable projects completed within the last five years. The document appears to be a standard pre-qualification assessment tool used to comprehensively screen potential contractors before awarding a contract, with Gilbane Building Company reserving the right to request additional financial statements for review.
View the file
Other files
Show all 14
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
APPENDIX A – CONTRACTOR INFORMATION FORM
1. Contractor Information
Contractor Name: __________
Address: ______ _________________ ______
Number of years in business as the Contractor named above ____ ________
Physical Business Headquarters Address: _____________________________________________
Previous Contractor Names: _______________________________________________________
Explanation for Contractor Name Change: _____________________________________________
Phone Number: ____________________ Contact Email: _________________________________
2. Financial
Annual gross sales for last three (3) years:
20__ ______________ 20__ ___________ 20__ ___________ _
Federal ID Number: ________________
Dun & Bradstreet (D-U-N-S) Number: _____________________
Financial statements could be requested by Gilbane Building Company for review.
3. Business Structure
Corporation Partnership Individual Joint Venture Other _________________
State of Incorporation: ___________
States in which qualified to do business: _______________
4. Licenses
Provide all State and local licenses and license numbers held by Contractor:
5. Experience
Years of experience with same type projects as specified? ____________________________
Has the Contractor in the past five (5) years ever?
a. Failed to complete awarded work? __________________________________________
b. Been removed from awarded work? _________________________________________
c. Has the owner/principal(s) of the company ever filed bankruptcy?
d. Has the Contractor ever bonded a job for completion?
e. Are there any judgements, claims, arbitration proceedings, or suits pending or outstanding against the Contractor or its Officers?
6. Safety
In the last five (5) years has the Contractor or subcontractor companies have any violations of state, federal or local laws or regulations, including OSHA/MIOSHA, state of federal prevailing wages, wage and hour laws, workers’ compensation or unemployment compensation laws rules or regulations issued against the Contractor. If yes, explain violation(s).
Provide workman compensation experience modification rating. __________________________
7. Subcontractors
If using subcontractors on this project, provide what segments of work they will provide.
8. References
Provide a list of comparable projects you have completed within the last five (5) years.
File details come from the government source that posted it. Updated .