4-04 Required Forms Fillable.pdf

466 KB Posted

Attached to
Intersection Capacity Improvements (FY 23)
Solicitation number
26-53ITB
Issued by
Collin County, Texas

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This is a required forms document for the City of McKinney, Texas, containing contractor status information, qualifications statements, safety experience questionnaires, and acknowledgement forms necessary for bid submission on the Intersection Capacity Improvements (FY 23) project. The document requires contractors to complete sections identifying their business entity type (sole proprietor, partnership, corporation, or limited partnership), provide detailed contractor status information including registration numbers and principal office locations, and submit statements of bidding contractor qualifications and experience demonstrating a minimum of three years in the construction industry. Contractors must list completed projects with contract costs, completion dates, workdays allowed and required, and any liquidated damages assessed, as well as incomplete projects with projected completion dates and anticipated delays. The forms also require subcontractor qualifications statements for any subcontractors the bidding contractor intends to utilize on the project.

The document incorporates safety record evaluation criteria established by McKinney City Council under Texas Local Government Code Section 252.0435, requiring bidders to disclose OSHA citations, environmental protection violations, criminal convictions within the past ten years, and negligent acts resulting in serious bodily injury or death within the past decade. Bidders must answer specific safety questionnaire items regarding written safety programs, site inspections, safety training, lost time injury rates, workers compensation experience modification rates, and competent persons in specialized areas such as scaffolding, excavation, cranes, and fall protection. Bidders must provide documentation of business references including bank references, municipality references, and other credit references, and certify under oath that all information provided is true and accurate. Out-of-state contractors must comply with Texas Government Code Section 2252.002 regarding underbidding requirements relative to in-state competitors.

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2-06 Construction Agreement and Bonds.pdf PDF
6-03 Plans.pdf PDF
5-02 Bid Proposal.pdf PDF
1-05 Bid Bond.pdf PDF
3-01 Construction Specifcations.pdf PDF

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CONTRACTOR STATUS INFORMATION

Instructions: Please fill in the appropriate section below for the type of business entity through which Contractor operates, completing all blanks within the section. This information is necessary to ensure that the contract and bonds are in the correct form.

SECTION 1: If the contractor is a SOLE PROPRIETOR, fill in this section only:

Name:

First Middle Last

Name under which you are engaged in business (if operating under an assumed name):

Residence:

Street City County State ZIP

Business:

Street City County State ZIP

Principal place of business:

City County State ZIP

Contact Person:

Name Phone

SECTION 2: If the contractor is a PARTNERSHIP, fill in this section only:

Name of Partner:

First Middle Last

Residence:

Street City County State ZIP

Name of Partner:

First Middle Last

Residence:

Name under which contractor conducts business (if operating under an assumed name):

Business Address:

Principal place of business:

City County State Zip

Contact Person:

Name Phone

Texas Secretary of State Filing number: _____________________

SECTION 3: If the contractor is a CORPORATION, fill in this section only:

Registered name of corporation:

Doing business as:

Date charter expires:

State of corporation:

Date of corporation filing: (If non-Texas corporation, date of Certificate of Authority Issuance).

Texas Secretary of State Filing number: _____________________

Registered Agent:

First Middle Last

Address:

Location of Corporation principal office:

Person executing contract on behalf of corporation: (Please print)

Name:

First Middle Last

Title:

Address:

Street City County State ZIP

Telephone Number:

SECTION 4: If the contractor is a LIMITED PARTNERSHIP, fill in this section only:

Registered name of limited partnership:

Doing business as:

Date charter, if any, expires:

State of creation:

Date of registration or filing, if any: (If non-Texas corporation, date of Certificate of Authority Issuance).

Registered Agent:

First Middle Last

Address:

Street City County State ZIP

Location of limited partnership principal office:

Street City County State ZIP

Registered name of limited partnership’s general partner:

Doing business as:

Date charter, if any, expires:

State of corporation or creation:

Date of corporation filing, if any: (If non-Texas corporation, date of Certificate of Authority Issuance).

Texas Secretary of State Filing number: _____________________

Registered Agent:

First Middle Last

Address:

Street City County State ZIP

Location of general partner’s principal office:

Street City County State ZIP

Person executing contract on behalf of general partner for limited partnership: (Please print)

Name:

First Middle Last

Title:

Address:

Telephone Number:

OUT OF STATE CONTRACTOR COMPLIANCE TO STATE LAW

Texas Government Code § 2252.002 provides that, in order to be awarded a contract as low bidder, a non-resident bidder (out-of-state contractor whose corporate office or principal place of business is outside the State of Texas) bid projects in Texas at an amount lower than the lowest Texas resident bidder by the same amount that a Texas resident bidder would be required to underbid a non-resident bidder in order to obtain a comparable contract in the state in which the non-resident's principal place of business is located. The appropriate blanks in the following statement must be filled out by all out-of-state or non-resident bidders in order for those bids to meet specifications. (This information may be obtained from the Texas Register.) The failure of out-of-state or non-resident contractors to do so will automatically disqualify that bidder.

Non-resident contractor in ___________________ (give state), our principal place of business, is required to be _________ percent lower than resident bidders by State Law. A copy of the statute is attached.

Non-resident contractor in ___________________ (give state), our principal place of business, is not required to underbid resident bidders.

BIDDER

By Company (Please Print)

Address Signature

City State Zip Title (Please Print)

STATEMENT OF BIDDING CONTRACTOR’S QUALIFICATIONS AND EXPERIENCE

CONTRACTOR _____________________________________________________

Note: Demonstrate a minimum of three years’ experience. The information provided to the City on this form will be used, in part at least, to determine whether the perceived low bidder is the responsible low bidder for purposes of this Project.

PLEASE RESPOND TO THE FOLLOWING QUESTIONS:

1. Number of years in business as a General Contractor performing the type(s) of work required for this Project. ______________________________.

2. Types of work performed:

� Asphalt Paving � Concrete Structures � Miscellaneous Concrete

� Auxiliary Lanes � Demolition � Storm Sewer

� Bridge Work � Earth Work � Subgrade Preparation

� Channel Lining � Fencing � Other ____________

� Concrete Paving � Landscaping � _________________

3. Greatest number of contracts in excess of $500,000.00 under construction at one time in company’s history. ______________________________.

4. Greatest number of contracts in excess of $1,000,000.00 under construction at one time in company’s history. ______________________________.

5. Approximate average of dollar value of incomplete work outstanding under contacts at any one time. ______________________________.

6. List completed projects of the type of work of this Project or similar work plus the following information on each such project (use attachments for additional work if necessary).

NAME OF PROJECT: ____________________________________________________

OWNER: ______________________________________________________________

POINT OF CONTACT: ____________________________ PHONE: ________________

TOTAL CONTRACT COST: ______________COMPLETION DATE: ______________

DESCRIPTION: _________________________________________________________

Number Workdays Allowed: _________ Number Workdays Required: __________

Extra Days Granted: __________ Amount Liquidated Damages: _________________

NAME OF PROJECT: ____________________________________________________

OWNER: ______________________________________________________________

POINT OF CONTACT: ____________________________ PHONE: ________________

TOTAL CONTRACT COST: ______________COMPLETION DATE: ______________

DESCRIPTION: _________________________________________________________

POINT OF CONTACT: ____________________________ PHONE: ________________

TOTAL CONTRACT COST: ______________COMPLETION DATE: ______________

DESCRIPTION: _________________________________________________________

POINT OF CONTACT: ____________________________ PHONE: ________________

TOTAL CONTRACT COST: ______________COMPLETION DATE: ______________

DESCRIPTION: _________________________________________________________

POINT OF CONTACT: ____________________________ PHONE: ________________

TOTAL CONTRACT COST: ______________COMPLETION DATE: ______________

DESCRIPTION: _________________________________________________________

7. List incomplete projects, plus the following information on each such project (use attachments for additional work if necessary).

POINT OF CONTACT: ____________________________ PHONE: ________________

CONTRACT COST: ___________ PROJECTED COMPLETION DATE: ___________

Number Workdays Allowed: _________ Number Workdays used to date: ________

Extra Days Granted: __________ Anticipated Late Days, if any: _________________

8. Have you or any present partner(s) or officer(s) failed to complete a contract? _____ If yes, please list the projects for which contracts were not completed, plus the following information on each such project (use attachments for additional work if necessary).

COMPANY NAME, if different: _____________________________________________

NAME OF PARTNER / OFFICER: __________________________________________

OWNER: ______________________________________________________________

POINT OF CONTACT: ____________________________ PHONE: ________________

CONTRACT COST: ___________ DEFAULT / TERMINATION DATE: ____________

DESCRIPTION: _________________________________________________________

SURETY: ______________________________________________________________

POINT OF CONTACT: ____________________________ PHONE: _______________

PERFORMANCE / PAYMENT BOND NUMBERS: ______________________________

NAME OF PARTNER / OFFICER: __________________________________________

OWNER: ______________________________________________________________

POINT OF CONTACT: ____________________________ PHONE: ________________

CONTRACT COST: ___________ DEFAULT / TERMINATION DATE: ____________

DESCRIPTION: _________________________________________________________

SURETY: ______________________________________________________________

NAME OF PARTNER / OFFICER: __________________________________________

CONTRACT COST: ___________ DEFAULT / TERMINATION DATE: ____________

SURETY: ______________________________________________________________

NAME OF PARTNER / OFFICER: __________________________________________

OWNER: ______________________________________________________________

POINT OF CONTACT: ____________________________ PHONE: ________________

CONTRACT COST: ___________ DEFAULT / TERMINATION DATE: ____________

DESCRIPTION: _________________________________________________________

SURETY: ______________________________________________________________

NAME OF PARTNER / OFFICER: __________________________________________

OWNER: ______________________________________________________________

POINT OF CONTACT: ____________________________ PHONE: ________________

CONTRACT COST: ___________ DEFAULT / TERMINATION DATE: ____________

DESCRIPTION: _________________________________________________________

SURETY: ______________________________________________________________

9. Are there any unsatisfied demands upon you regarding your accounts payable? If yes, give names, amounts and explanations (use attachments for additional unsatisfied demands if necessary). __________________________________________________

10. Have you or any present partner(s) or officer(s) been convicted of a felony or a crime involving moral turpitude (i.e., theft, bribery, fraud, perjury and so forth) within the past ten (10) years? _____ If yes, please list the date of each such conviction, the identity of the person(s) so convicted, the crime for which each such person was convicted, the sentence(s) issued for each such conviction, the current status of the sentence(s) and whether the conviction was related to any project(s) for which contracts were awarded by a governmental entity (use attachments for additional convictions if necessary).

11. Have you or any present partner(s) or officer(s) been debarred, or otherwise disqualified, from receiving or participating in federal contracts or federally approved subcontracts or from any type of federal financial or nonfinancial assistance or benefits? _____ If yes, please explain the facts surrounding such debarment in detail by identifying the project giving rise to debarment, the action date and termination date of debarment, and the cause(s) for debarment (use attachments for additional debarments if necessary). ________________________________________

12. Bank Reference.

NAME OF BANK: __________________________________________________________

BANK OFFICER: ___________________________________ PHONE: _________________

MAILING ADDRESS: __________________________________________________________

_________________________________________________ FAX: ___________________

NAME OF BANK: __________________________________________________________

BANK OFFICER: ___________________________________ PHONE: _________________

MAILING ADDRESS: __________________________________________________________

_________________________________________________ FAX: ___________________

13. Municipality References

NAME OF CITY: __________________________________________________________

CONTACT PERSON: ________________________________ TITLE: ___________________

PHONE: _________________ FAX: ___________________

MAILING ADDRESS: __________________________________________________________

PHONE: _________________ FAX: ___________________

PHONE: _________________ FAX: ___________________

14. Other credit references

NAME OF REFERENCE: _______________________________________________________

PHONE: _________________ FAX: ___________________

PHONE: _________________ FAX: ___________________

PHONE: _________________ FAX: ___________________

ACKNOWLEDGEMENT

(Use this form if the Contractor is a sole proprietorship)

THE STATE OF TEXAS §

COUNTY OF _____________ §

I certify that my responses and the information provided are true and correct to the best of my personal knowledge and belief and that I have made no willful misrepresentations in this Statement of Qualifications and Experience (“Statement”), nor have I withheld any relevant information in my statements and answers to questions. I am aware that any information given by me in this Statement may be investigated and I hereby give my full permission for any such investigation, and I fully acknowledge that any misrepresentations or omissions in my responses and information may cause my bid to be rejected.

a ____________ Sole Proprietorship, By: ______________________________ Name: ________________________

Date Signed: ____________________

THE STATE OF TEXAS §

COUNTY OF _____________ §

This instrument was acknowledged before me on the ______ day of ________________, 20_____, by _______________________, in their capacity as owner of _________________, a ____________ sole proprietorship, known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that they executed the same for the purposes therein expressed.

GIVEN UNDER MY HAND AND SEAL OF OFFICE, THIS THE

DAY OF , 20_____.

Notary Public County, Texas My commission expires

(Use this form if the Contractor is an ordinary partnership.)

THE STATE OF TEXAS §

COUNTY OF _____________ §

I certify that my responses and the information provided are true and correct to the best of my personal knowledge and belief and that I have made no willful misrepresentations in this Statement of Qualifications and Experience (“Statement”), nor have I withheld any relevant information in my statements and answers to questions. I am aware that any information given by me in this Statement may be investigated and I hereby give my full permission for any such investigation, and I fully acknowledge that any misrepresentations or omissions in my responses and information may cause my bid to be rejected.

a ____________ Partnership, By and through its Partner

By: ______________________________ Name: ________________________

Date Signed: ____________________

This instrument was acknowledged before me on the ______ day of ________________, 20_____, by _______________________, in their capacity as a partner of _________________, a ____________ partnership, known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that they executed the same on behalf of and as the act of the partnership..

GIVEN UNDER MY HAND AND SEAL OF OFFICE, THIS THE

DAY OF , 20_____.

(Use this form if the Contractor is a corporation)

I certify that my responses and the information provided are true and correct to the best of my personal knowledge and belief and that I have made no willful misrepresentations in this Statement of Qualifications and Experience (“Statement”), nor have I withheld any relevant information in my statements and answers to questions. I am aware that any information given by me in this Statement may be investigated and I hereby give my full permission for any such a ____________ Corporation, Title: _________________________

20_____, by _______________________, in their capacity as _____________ of _________________, a ____________ Corporation, known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that they executed the same on behalf of and as the act of the corporation.

(Use this form if the Contractor is a limited partnership.)

I certify that my responses and the information provided are true and correct to the best of my personal knowledge and belief and that I have made no willful misrepresentations in this Statement of Qualifications and Experience (“Statement”), nor have I withheld any relevant information in my statements and answers to questions. I am aware that any information given by me in this Statement may be investigated and I hereby give my full permission for any such a ____________ Limited Partnership, By and through its General Partner a ____________________________, _________________, a ___________________, known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that ___________________, is the general partner of _______________________, a ____________ Limited Partnership, and that they executed the same on behalf of and as the act of the limited partnership.

STATEMENT OF SUBCONTRACTOR’S QUALIFICATIONS AND EXPERIENCE

SUBCONTRACTOR _____________________________________________________

Note: Demonstrate a minimum of three years’ experience for each subcontractor the Bidding Contractor intends to use on the Project (use attachments for additional subcontractors if necessary).

NAME OF PROJECT: __________________________________________________________

OWNER:

POINT OF CONTACT: ___________________________ PHONE: __________________

GENERAL CONTRACTOR:

POINT OF CONTACT: ___________________________ PHONE: __________________

TOTAL CONTRACT COST: ________________ COMPLETION DATE: ______________

DESCRIPTION: _______________________________________________________________

Number Workdays Allowed: _____________ Number Workdays Required: __________

Extra Days Granted: __________ Amount Liquidated Damages Assessed, if any: _________

NAME OF PROJECT: __________________________________________________________

OWNER:

POINT OF CONTACT: ___________________________ PHONE: __________________

GENERAL CONTRACTOR:

POINT OF CONTACT: ___________________________ PHONE: __________________

TOTAL CONTRACT COST: ________________ COMPLETION DATE: ______________

DESCRIPTION: _______________________________________________________________

NAME OF PROJECT: __________________________________________________________

OWNER:

POINT OF CONTACT: ___________________________ PHONE: __________________

GENERAL CONTRACTOR:

POINT OF CONTACT: ___________________________ PHONE:

TOTAL CONTRACT COST: ________________ COMPLETION DATE: ______________

DESCRIPTION: _______________________________________________________________

RECORD QUESTIONNAIRE & STATEMENT OF BIDDER’S SAFETY EXPERIENCE

Pursuant to Section 252.0435 of the Local Government Code, the McKinney City Council will consider the safety records of potential contractors prior to awarding bids on City contracts. The City of McKinney has adopted the following written definitions and criteria for accurately determining the safety record of a bidder prior to awarding bids on City contracts. The term “bidder” includes the firm, corporation, partnership, or other legal entity represented by the bidder or anyone acting for such firm, corporation, partnership or other entity submitting the bid. The definitions and criteria for determining the safety record of a bidder are:

“Citations” include notices of violation, notices of enforcement, suspension/revocations of state or federal licenses or registrations, fines assessed pending criminal complaints, indictments, or convictions, administrative orders, draft orders, final orders, and judicial final judgments. Notice of Violations and Notice of Enforcement received from the TCEQ shall include those classified as major violations and moderate violations under the TCEQ’S regulations for documentation of Compliance History, 30 Texas Administrative Code, Chapter 60.2 (c) (1) and (2).

“Environmental Protection Agency” includes, but is not limited to the Texas Commission on Environmental Quality (TCEQ), the U.S. Environmental Protection Agency (EPA), the U.S. Fish and Wildlife Service, the U.S. Army Corps of Engineers, the Texas Department of Health, the Texas Parks and Wildlife Department, the Structural Pest Control Service, agencies of local governments responsible for enforcing environmental protection laws or regulations, and similar regulatory agencies of other states of the United States.

1. If the Bidder’s response to the following questions reveals more than two (2) cases in which final orders have been entered by the Occupational Safety and Health Review Commission (OSHRC) against the bidder for serious violations of Occupational Safety & Health Administration (OSHA) regulations within the past five (5) years, the City will, at its discretion, determine whether to disqualify the bidder.

2. If the Bidder’s response to the following questions reveals more than one (1) case in which

Bidder has received a Citation or for which final orders have been entered from an environmental protection agency for violations within the past five (5) years, the City will, at its discretion, determine whether to disqualify the bidder.

3. If the Bidder’s response to the following questions reveals that the Bidder has been convicted of a criminal offense within the past ten (10) years or has been subject to a judgment for a negligent act or omission, which resulted in serious bodily harm or death, at its discretion, the City will determine whether to disqualify the bidder.

4. The City may consider the responses to each question listed below separately when making a discretionary determination of whether to disqualify a Bidder and it may consider the cumulative impact of the information generated by the Bidder’s responses in making the determination.

5. In order to consider the safety records of potential contractors prior to awarding bids on

City contracts, the City requires that Bidders answer the following four (4) questions and submit them with their bids:

QUESTION ONE

Has the “Bidder” received any Citations for violations of OSHA within the past five (5) years? � Yes � No

QUESTION TWO

Has the Bidder received any Citations for violations of environmental protection laws or regulations within the past five (5) years? � Yes � No

QUESTION THREE

Has the Bidder ever been convicted, within the past ten (10) years of a criminal offense which resulted in or gave rise to serious bodily injury or death? � Yes � No

QUESTION FOUR

Has the Bidder ever been sued, within the past ten (10) years, for a negligent or wrongful intentional act or omission arising out of or in conjunction with a project on which the Bidder worked that resulted in or gave rise to serious bodily injury or death? � Yes � No

If the Bidder has indicated "Yes" to Questions 1, 2 and/or 3 above, the Bidder must provide to the City, with its bid submission, the following information:

(a) Date of Citation or offense and location where violation or offense occurred;

(b) Type of violation or offense;

(c) Final disposition of violation or offense, if any; and,

(d) Penalty assessed.

If the Bidder has indicated "Yes" to Question 4 above, the Bidder must provide to the City, with its bid submission, the following information:

(a) Date of negligent or wrongful intentional act or omission and location where such act or omission occurred;

(b) Type of negligent or wrongful intentional act or omission asserted;

(c) Whether gross negligence was asserted;

(d) Whether a finding of gross negligence was made;

(e) Final disposition of litigation, if any; and,

(f) Amount of judgment awarded.

In addition, the City will utilize the following information and, in its discretion, as additional support to make any discretionary determination of whether to disqualify a Bidder. Accordingly, Bidder must answer the following questions and provide evidence that it meets minimum OSHA construction safety standards and has a lost time injury rate that does not exceed the limits established below:

1. Does the Bidder have a written construction safety program? � Yes � No

2. Does the Bidder conduct regular construction site safety inspections? � Yes � No

3. Does the Bidder have an active construction safety training program? � Yes � No

4. Has the Bidder been fined by OSHA for any willful safety violations in the past three (3) years? � Yes � No

5. Does the Bidder have a lost time injury rate and a total recordable injury rate of less than or equal to the national average for North American Industrial Classification System (NAICS) Category 23 for each of the past five (5) years? (Attach the Bidder's OSHA 300/300A logs for the past five (5) years) � Yes � No

6. Does the Bidder have an experience modifier rate of 1.0 or less? (Attach the

Bidder's NCCI workers compensation experience rating sheets for the past five (5) years) � Yes � No

7. Does the Bidder or affected subcontractors have competent persons in the following areas (as applicable to the scope of the current Project):

A. Scaffolding � Yes � No � N/A B. Excavation � Yes � No � N/A C. Cranes & Hoists � Yes � No � N/A D. Electrical � Yes � No � N/A E. Fall Protection � Yes � No � N/A F. Confined Spaces � Yes � No � N/A G. Material Handling � Yes � No � N/A H. Demolition � Yes � No � N/A I. Steel Erection � Yes � No � N/A J. Underground Construction � Yes � No � N/A

8. Has the “Bidder” had any OSHA inspections within the past six (6) months for which no Citations have been received or for which any Citations have been resolved or vacated? � Yes � No

If the Bidder has indicated “YES” to questions 4, 5, 6, or 8 above, the Bidder must provide to the City, with its bid submission, sufficient supporting documentation to indicate the nature and magnitude of the underlying issues.

(Use this form if the Contractor is a sole proprietorship)

I certify that my responses and the information provided are true and correct to the best of my personal knowledge and belief and that I have made no willful misrepresentations in this Questionnaire, nor have I withheld any relevant information in my statements and answers to questions. I am aware that any information given by me in this questionnaire may be investigated and I hereby give my full permission for any such investigation, and I fully acknowledge that any misrepresentations or omissions in my responses and information may cause my bid to be rejected.

a ____________ Sole Proprietorship, 20_____, by _______________________, in their capacity as owner of _________________, a ____________ sole proprietorship, known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that they executed the same for the purposes therein expressed.

(Use this form if the Contractor is an ordinary partnership.)

I certify that my responses and the information provided are true and correct to the best of my personal knowledge and belief and that I have made no willful misrepresentations in this Questionnaire, nor have I withheld any relevant information in my statements and answers to questions. I am aware that any information given by me in this questionnaire may be investigated and I hereby give my full permission for any such investigation, and I fully acknowledge that any a ____________ Partnership, By and through its Partner

20_____, by _______________________, in their capacity as a partner of _________________, a ____________ partnership, known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that they executed the same on behalf of and as the act of the partnership..

(Use this form if the Contractor is a corporation)

I certify that my responses and the information provided are true and correct to the best of my personal knowledge and belief and that I have made no willful misrepresentations in this Questionnaire, nor have I withheld any relevant information in my statements and answers to questions. I am aware that any information given by me in this questionnaire may be investigated and I hereby give my full permission for any such investigation, and I fully acknowledge that any a ____________ Corporation, _________________, a ____________ Corporation, known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that they executed the same on behalf of and as the act of the corporation.

(Use this form if the Contractor is a limited partnership.)

I certify that my responses and the information provided are true and correct to the best of my personal knowledge and belief and that I have made no willful misrepresentations in this Questionnaire, nor have I withheld any relevant information in my statements and answers to questions. I am aware that any information given by me in this questionnaire may be investigated and I hereby give my full permission for any such investigation, and I fully acknowledge that any a ____________ Limited Partnership, By and through its General Partner a ____________________________, _________________, a ___________________, known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that ___________________, is the general partner of _______________________, a ____________ Limited Partnership, and that they executed the same on behalf of and as the act of the limited partnership.

01_Contractor Status Information
CONTRACTOR STATUS INFORMATION
02_Out of State Contractor Compliance to State Law
OUT OF STATE CONTRACTOR COMPLIANCE TO STATE LAW
03_Statement of Bidding Contractors Qualifications and Experience
STATEMENT OF BIDDING CONTRACTOR’S QUALIFICATIONS AND EXPERIENCE
04_Statement of Subcontractors Qualifications and Experience
STATEMENT OF SUBCONTRACTOR’S QUALIFICATIONS AND EXPERIENCE
05_Record Question and Statement of Bidders Safety Experience
RECORD QUESTIONNAIRE & STATEMENT OF BIDDER’S SAFETY EXPERIENCE
First:
Middle:
Last:
Residence:
Street:
City:
County:
State:
ZIP:
Street_2:
City_2:
County_2:
State_2:
ZIP_2:
City_3:
County_3:
State_3:
Name:
Phone:
First_2:
Middle_2:
Last_2:
Street_3:
City_4:
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State_4:
ZIP_3:
First_3:
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Name under which contractor conducts business if operating under an assumed name:
Street_5:
City_6:
County_6:
State_6:
ZIP_5:
Principal place of business:
Contact Person:
Texas Secretary of State Filing number:
Registered name of corporation:
Doing business as:
Date charter expires:
State of corporation:
Date of corporation filing:
Texas Secretary of State Filing number_2:
Registered Agent:
Address:
Street_6:
City_7:
County_7:
State_7:
ZIP_6:
Name_2:
Title:
Address_2:
Telephone Number:
Registered name of limited partnership:
Doing business as_2:
Date charter if any expires:
State of creation:
Date of registration or filing if any:
Registered Agent_2:
Address_3:
Street_7:
City_8:
County_8:
State_8:
ZIP_7:
Registered name of limited partnerships general partner:
Doing business as_3:
Date charter if any expires_2:
State of corporation or creation:
Date of corporation filing if any:
Texas Secretary of State Filing number_3:
Registered Agent_3:
Address_4:
Street_8:
City_9:
County_9:
State_9:
ZIP_8:
Name_3:
Title_2:
Address_5:
Telephone Number_2:
required to be:
percent lower than resident bidders by State Law A copy of the statute:
not required to underbid resident bidders:
Company:
Address_6:
City_10:
State_10:
Zip:
Please Print:
Title Please Print:
CONTRACTOR:
Other:
undefined:
companys history:
in companys history:
one time:
NAME OF PROJECT:
OWNER:
POINT OF CONTACT:
PHONE:
TOTAL CONTRACT COST:
COMPLETION DATE:
DESCRIPTION:
Number Workdays Allowed:
Number Workdays Required:
Extra Days Granted:
Amount Liquidated Damages:
NAME OF PROJECT_2:
OWNER_2:
POINT OF CONTACT_2:
PHONE_2:
TOTAL CONTRACT COST_2:
COMPLETION DATE_2:
DESCRIPTION_2:
Number Workdays Allowed_2:
Number Workdays Required_2:
Extra Days Granted_2:
Amount Liquidated Damages_2:
NAME OF PROJECT_3:
OWNER_3:
POINT OF CONTACT_3:
PHONE_3:
TOTAL CONTRACT COST_3:
COMPLETION DATE_3:
DESCRIPTION_3:
Number Workdays Allowed_3:
Number Workdays Required_3:
Extra Days Granted_3:
Amount Liquidated Damages_3:
NAME OF PROJECT_4:
OWNER_4:
POINT OF CONTACT_4:
PHONE_4:
TOTAL CONTRACT COST_4:
COMPLETION DATE_4:
DESCRIPTION_4:
Number Workdays Allowed_4:
Number Workdays Required_4:
Extra Days Granted_4:
Amount Liquidated Damages_4:
NAME OF PROJECT_5:
OWNER_5:
POINT OF CONTACT_5:
PHONE_5:
TOTAL CONTRACT COST_5:
COMPLETION DATE_5:
DESCRIPTION_5:
Number Workdays Allowed_5:
Number Workdays Required_5:
Extra Days Granted_5:
Amount Liquidated Damages_5:
NAME OF PROJECT_6:
OWNER_6:
POINT OF CONTACT_6:
PHONE_6:
CONTRACT COST:
PROJECTED COMPLETION DATE:
DESCRIPTION_6:
Number Workdays Allowed_6:
Number Workdays used to date:
Extra Days Granted_6:
Anticipated Late Days if any:
NAME OF PROJECT_7:
OWNER_7:
POINT OF CONTACT_7:
PHONE_7:
CONTRACT COST_2:
PROJECTED COMPLETION DATE_2:
DESCRIPTION_7:
Number Workdays Allowed_7:
Number Workdays used to date_2:
Extra Days Granted_7:
Anticipated Late Days if any_2:
NAME OF PROJECT_8:
OWNER_8:
POINT OF CONTACT_8:
PHONE_8:
CONTRACT COST_3:
PROJECTED COMPLETION DATE_3:
DESCRIPTION_8:
Number Workdays Allowed_8:
Number Workdays used to date_3:
Extra Days Granted_8:
Anticipated Late Days if any_3:
NAME OF PROJECT_9:
OWNER_9:
POINT OF CONTACT_9:
PHONE_9:
CONTRACT COST_4:
PROJECTED COMPLETION DATE_4:
DESCRIPTION_9:
Number Workdays Allowed_9:
Number Workdays used to date_4:
Extra Days Granted_9:
Anticipated Late Days if any_4:
NAME OF PROJECT_10:
OWNER_10:
POINT OF CONTACT_10:
PHONE_10:
CONTRACT COST_5:
PROJECTED COMPLETION DATE_5:
DESCRIPTION_10:
Number Workdays Allowed_10:
Number Workdays used to date_5:
Extra Days Granted_10:
Anticipated Late Days if any_5:
Have you or any present partners or officers failed to complete a contract:
NAME OF PROJECT_11:
COMPANY NAME if different:
NAME OF PARTNER OFFICER:
OWNER_11:
POINT OF CONTACT_11:
PHONE_11:
CONTRACT COST_6:
DEFAULT TERMINATION DATE:
DESCRIPTION_11:
SURETY:
POINT OF CONTACT_12:
PHONE_12:
PERFORMANCE PAYMENT BOND NUMBERS:
NAME OF PROJECT_12:
COMPANY NAME if different_2:
NAME OF PARTNER OFFICER_2:
OWNER_12:
POINT OF CONTACT_13:
PHONE_13:
CONTRACT COST_7:
DEFAULT TERMINATION DATE_2:
DESCRIPTION_12:
SURETY_2:
POINT OF CONTACT_14:
PHONE_14:
PERFORMANCE PAYMENT BOND NUMBERS_2:
NAME OF PROJECT_13:
COMPANY NAME if different_3:
NAME OF PARTNER OFFICER_3:
OWNER_13:
POINT OF CONTACT_15:
PHONE_15:
CONTRACT COST_8:
DEFAULT TERMINATION DATE_3:
DESCRIPTION_13:
SURETY_3:
POINT OF CONTACT_16:
PHONE_16:
PERFORMANCE PAYMENT BOND NUMBERS_3:
NAME OF PROJECT_14:
COMPANY NAME if different_4:
NAME OF PARTNER OFFICER_4:
OWNER_14:
POINT OF CONTACT_17:
PHONE_17:
CONTRACT COST_9:
DEFAULT TERMINATION DATE_4:
DESCRIPTION_14:
SURETY_4:
POINT OF CONTACT_18:
PHONE_18:
PERFORMANCE PAYMENT BOND NUMBERS_4:
NAME OF PROJECT_15:
COMPANY NAME if different_5:
NAME OF PARTNER OFFICER_5:
OWNER_15:
POINT OF CONTACT_19:
PHONE_19:
CONTRACT COST_10:
DEFAULT TERMINATION DATE_5:
DESCRIPTION_15:
SURETY_5:
POINT OF CONTACT_20:
PHONE_20:
PERFORMANCE PAYMENT BOND NUMBERS_5:
give names amounts and explanations use attachments for additional unsatisfied:
demands if necessary 1:
demands if necessary 2:
involving moral turpitude ie theft bribery fraud perjury and so forth within the:
a governmental entity use attachments for additional convictions if necessary 1:
a governmental entity use attachments for additional convictions if necessary 2:
a governmental entity use attachments for additional convictions if necessary 3:
approved subcontracts or from any type of federal financial or nonfinancial:
termination date of debarment and the causes for debarment use attachments for:
additional debarments if necessary 1:
additional debarments if necessary 2:
Bank Reference:
NAME OF BANK:
undefined_2:
PHONE_21:
MAILING ADDRESS:
FAX:
undefined_3:
NAME OF BANK_2:
undefined_4:
PHONE_22:
MAILING ADDRESS_2:
FAX_2:
NAME OF CITY:
CONTACT PERSON:
TITLE:
PHONE_23:
FAX_3:
MAILING ADDRESS 1:
MAILING ADDRESS 2:
NAME OF CITY_2:
CONTACT PERSON_2:
TITLE_2:
PHONE_24:
FAX_4:
MAILING ADDRESS 1_2:
MAILING ADDRESS 2_2:
NAME OF CITY_3:
CONTACT PERSON_3:
TITLE_3:
PHONE_25:
FAX_5:
MAILING ADDRESS 1_3:
MAILING ADDRESS 2_3:
NAME OF REFERENCE:
CONTACT PERSON_4:
TITLE_4:
PHONE_26:
FAX_6:
MAILING ADDRESS 1_4:
MAILING ADDRESS 2_4:
NAME OF REFERENCE_2:
CONTACT PERSON_5:
TITLE_5:
PHONE_27:
FAX_7:
MAILING ADDRESS_3:
NAME OF REFERENCE_3:
CONTACT PERSON_6:
TITLE_6:
PHONE_28:
FAX_8:
MAILING ADDRESS 1_5:
MAILING ADDRESS 2_5:
undefined_5:
a:
By:
Name_4:
This instrument was acknowledged before me on the:
day of:
20:
by:
in their capacity as owner of:
the foregoing instrument and acknowledged to me that they executed the same for the purposes:
GIVEN UNDER MY HAND AND SEAL OF OFFICE THIS THE:
DAY OF:
20_2:
County Texas:
Notary Public:
My commission expires:
undefined_6:
a_2:
undefined_7:
By_2:
Name_5:
This instrument was acknowledged before me on the_2:
day of_2:
20_3:
by_2:
in their capacity as a partner of:
a_3:
GIVEN UNDER MY HAND AND SEAL OF OFFICE THIS THE_2:
DAY OF_2:
20_4:
County Texas_2:
Notary Public_2:
My commission expires_2:
undefined_8:
a_4:
By_3:
Name_6:
Title_3:
This instrument was acknowledged before me on the_3:
day of_3:
20_5:
by_3:
as:
a_5:
is subscribed to the foregoing instrument and acknowledged to me that they executed the same:
GIVEN UNDER MY HAND AND SEAL OF OFFICE THIS THE_3:
DAY OF_3:
20_6:
County Texas_3:
Notary Public_3:
My commission expires_3:
undefined_9:
a_6:
undefined_10:
a_7:
By_4:
Name_7:
Title_4:
This instrument was acknowledged before me on the_4:
day of_4:
20_7:
by_4:
as_2:
undefined_11:
a_8:
subscribed to the foregoing instrument and acknowledged to me that:
the general partner of:
a_9:
GIVEN UNDER MY HAND AND SEAL OF OFFICE THIS THE_4:
DAY OF_4:
20_8:
County Texas_4:
Notary Public_4:
My commission expires_4:
SUBCONTRACTOR:
NAME OF PROJECT_16:
POINT OF CONTACT_21:
PHONE_29:
GENERAL CONTRACTOR:
POINT OF CONTACT_22:
PHONE_30:
TOTAL CONTRACT COST_6:
COMPLETION DATE_6:
DESCRIPTION_16:
Number Workdays Allowed_11:
Number Workdays Required_6:
Extra Days Granted_11:
Amount Liquidated Damages Assessed if any:
NAME OF PROJECT_17:
OWNER_16:
POINT OF CONTACT_23:
PHONE_31:
GENERAL CONTRACTOR_2:
POINT OF CONTACT_24:
PHONE_32:
TOTAL CONTRACT COST_7:
COMPLETION DATE_7:
DESCRIPTION_17:
Number Workdays Allowed_12:
Number Workdays Required_7:
Extra Days Granted_12:
Amount Liquidated Damages Assessed if any_2:
NAME OF PROJECT_18:
POINT OF CONTACT_25:
PHONE_33:
GENERAL CONTRACTOR_3:
POINT OF CONTACT_26:
PHONE_34:
TOTAL CONTRACT COST_8:
COMPLETION DATE_8:
DESCRIPTION_18:
Number Workdays Allowed_13:
Number Workdays Required_8:
Extra Days Granted_13:
Amount Liquidated Damages Assessed if any_3:
undefined_12:
a_10:
By_5:
Name_8:
This instrument was acknowledged before me on the_5:
day of_5:
20_9:
by_5:
in their capacity as owner of_2:
the foregoing instrument and acknowledged to me that they executed the same for the purposes_2:
GIVEN UNDER MY HAND AND SEAL OF OFFICE THIS THE_5:
DAY OF_5:
20_10:
County Texas_5:
Notary Public_5:
My commission expires_5:
undefined_13:
a_11:
undefined_14:
By_6:
Name_9:
This instrument was acknowledged before me on the_6:
day of_6:
20_11:
by_6:
in their capacity as a partner of_2:
a_12:
GIVEN UNDER MY HAND AND SEAL OF OFFICE THIS THE_6:
DAY OF_6:
20_12:
County Texas_6:
Notary Public_6:
My commission expires_6:
undefined_15:
a_13:
By_7:
Name_10:
Title_5:
This instrument was acknowledged before me on the_7:
day of_7:
20_13:
by_7:
as_3:
a_14:
is subscribed to the foregoing instrument and acknowledged to me that they executed the same_2:
GIVEN UNDER MY HAND AND SEAL OF OFFICE THIS THE_7:
DAY OF_7:
20_14:
County Texas_7:
Notary Public_7:
My commission expires_7:
undefined_16:
a_15:
undefined_17:
a_16:
By_8:
Name_11:
Title_6:
This instrument was acknowledged before me on the_8:
day of_8:
20_15:
by_8:
as_4:
undefined_18:
a_17:
subscribed to the foregoing instrument and acknowledged to me that_2:
the general partner of_2:
a_18:
GIVEN UNDER MY HAND AND SEAL OF OFFICE THIS THE_8:
DAY OF_8:
20_16:
County Texas_8:
Notary Public_8:
My commission expires_8:
required for this Project:
Check Box1: Off
Check Box2: Off
Check Box3: Off
Check Box4: Off
Check Box5: Off
Check Box6: Off
Check Box7: Off
Check Box8: Off
Check Box9: Off
Check Box10: Off
Check Box11: Off
Check Box12: Off
Check Box13: Off
Check Box14: Off
Check Box15: Off
Text16:
Text17:
Text18:
Text19:
Check Box20: Off
Check Box21: Off
Check Box22: Off
Check Box23: Off
Text28:
Text29:
Text30:
Text31:
Text32:
Text33:
Text34:
Text35:
Check Box24: Off
Check Box25: Off
Check Box26: Off
Check Box27: Off
Check Box28: Off
Check Box29: Off
Check Box30: Off
Check Box31: Off
Check Box32: Off
Check Box33: Off
Check Box34: Off
Check Box35: Off
Check Box36: Off
Check Box37: Off
Check Box38: Off
Check Box39: Off
Check Box40: Off
Check Box41: Off
Check Box42: Off
Check Box43: Off
Check Box44: Off
Check Box45: Off
Check Box46: Off
Check Box47: Off
Check Box48: Off
Check Box49: Off
Check Box50: Off
Check Box51: Off
Check Box52: Off
Check Box53: Off
Check Box54: Off
Check Box55: Off
Check Box56: Off
Check Box57: Off
Check Box58: Off
Check Box59: Off
Check Box60: Off
Check Box61: Off
Check Box62: Off
Check Box63: Off
Check Box64: Off
Check Box65: Off
Check Box66: Off
Check Box67: Off

File details come from the government source that posted it. Updated .