4-PRE-QUALIFICATION DOCUMENTS.docx

SECTION III

PRE-QUALIFICATION CHECKLIST

ALL CONTRACTORS MUST BE PRE-QUALIFIED

TO BID ON THIS PROJECT

Pre-Qualification Documents are due at the end of the Mandatory Pre-bid meeting scheduled for 9:30 AM on MONDAY, March 23, 2026, or forwarded to the planning office by 3:00 PM.

FOR

Mahoning Township – CDBG FY2024 Rich Avenue - Street Improvement Project Lawrence County, Pennsylvania

NOTICE TO CONTRACTORS:

The COUNTY reserves the right to waive any informality in or reject any or all bids or accept any bid, which it deems to be in its best interest.

* Include this checklist with the Pre-Qualification package.

Contractor’s Work Experience Questionnaire and Pre-Qualification Statement (Section III)

___________General Contractor Information

___________Contractor Job Capacity

_________ Contractor Financial & Bonding Information

___________ Section IX Compliance (company letterhead)

___________ Certification Regarding Debarment SBA Form 1623

____________MBE/WBE Section 3 Solicitation & Commitment Statement

*COMPLETE PRE-QUAL DOCUMENTS DUE AT PRE-BID MEETING*

CONTRACTOR WORK EXPERIENCE QUESTIONAIRE AND PRE-QUALIFICATION STATEMENT

Submitted To: Lawrence County Department Planning and Community Development 430 Court Street New Castle, PA 16101

For: __________________________________________

A. GENERAL CONTRACTOR INFORMATION

1) Official Company Name: __________________________________________________

Is this a: ( ) Corporation ( ) Partnership ( ) Sole Proprietorship

2) Your Principal Business Address (Location): ___________________________________

Mailing Address: ________________________________________________________

City: _______________________________ State: ___________ Zip: ______________

Telephone Number: __________________________ Fax: ______________________

Federal Tax ID Number: ___________________Emaill:_________________________

Name of Contact Person: _____________________ Cell Phone #: ________________

· If this is a Corporation:

Date Incorporated: ____________________ State of Incorporation: ________________

Names of President and Other Officers of the Corporation:

Name Title

· If this is a Partnership:

Date of Organization: ____________________ Type of Partnership: ________________

Please list the names of the Partners:

· If this a Sole Proprietor:

Number of years in business under your current Company Name: __________ Years

3) On all submissions by the Contractor (payroll form, etc.), if a person other than the person executing the contract documents will be signing documents, state the name and position of such persons having authority to do so.

4) How many years have you been engaged in the performance of work of the type required in the bidding documents? __________ Years

If yes, please attach a copy of the document. Please do not send full copies of safety manuals. An Index or Table of Contents from the manual is sufficient.

If yes, please provide this individual’s qualifications, work experience, authority, job duties, percentage of time spent in fulfilling his duties as a safety officer, and whom this individual report to.

7) Provide the number of OSHA Lost Workdays and Recordable Incidents and the associated Lost Workday Rate and Recordable Incident Rate for each year for the past two (2) years.

__________ # of Lost Workdays and Recordable Incidents

8) Please list all OSHA (or other health and safety agency) violations issued against your company for the last two (2) years. Please attach a description for each offense.

20___

20___

9) Please provide your Worker’s Compensation Experience Ratings (Experience Modifier) for the past two (2) years.

Year EMR

20____ ______

1) Number of full-time employees who would be dedicated to the project described in bidding documents:

Office: ________________ Field: _______________

2) Please attach the work history, years of experience and credentials of these individuals.

3) Describe the general character of work performed by your company:

4) Other business(es) your company actively participates in:

5) Have you ever undertaken business activities under any other name or through an entity other than that in which this bid is submitted?

_________ Yes _________ No If yes, please attach a complete listing of name(s).

6) Has your organization ever defaulted on a construction contract?

_________ Yes _________ No If yes, please attach details.

7) Has your company ever been engaged in litigation, arbitration, mediation, or any other dispute resolution mechanism, relative to the company’s involvement in a construction contract?

_________ Yes _________ No If yes, please attach details.

8) Attach a complete list of available equipment that you must have to perform the work for which you are bidding and state whether all such equipment is owned by you or what arrangements have been made to obtain the use of the same.

9) Range of contract values your company is interested in bidding for:

Minimum: $______________________ Maximum: $______________________

10) Attach a List of current contracts on hand in relation to work described in bidding documents Format similar to:

START

DATE

0BACTUAL/

1BANTICIPATED

COMPLETION DATE

C. CONTRACTOR FINANCIAL AND BONDING INFORMATION

1) Total value of work currently under contract:

2) Unencumbered credit amount available for the performance described in bidding documents:

4) Estimated Available Credit: $_____________________________________

Bank Name

Contract Person

Bank Address

Bank Telephone Number

Address

Telephone Number

6) Approximate Bonding Capacity: $______________________________

7) Bonding Capacity per Project Aggregate: $______________________________

All changes in subcontractors must first be approved by the Municipality, then by a Lawrence County designated administrator of the Community Development Block Grant for the County of Lawrence.

The bidder is presumed to have investigated and examined all of the plans, instructions, contract documents and the site, and the bid to be submitted will be made with full knowledge and understanding of the conditions and full scope of the work he is bidding on.

The Municipality, The Department of Community and Economic Development and/or Lawrence County may require further evidence of qualifications if they deem necessary.

The undersigned hereby authorizes and requests any person, firm, or corporation to furnish any information requested by the Municipality and/or its Administrators in verification of the recitals comprising this statement of Bidder’s Qualifications.

Dated at ________________________this __________ day of __________________, 20____.

Bidder: _________________________________________

By: ____________________________________________

Title: ___________________________________________

State of: ________________________________________

County of: _______________________________________

I, _________________________________________ being duly sworn, depose and say that he or she is __________________________ of ________________________, Name/ title of Authorized Signer Company Name

And that the answers to the foregoing questions and all statements therein contained are true and correct.

Subscribed and sworn to before me this ______________ day of _________________, 20___.

Notary Public

My Commission Expires _________________________________, 20____.

D. SECTION IX COMPLIANCE LETTER

(Compliance Letter on Company Letterhead)

The purpose of this letter is to formalize our intentions to comply with all facets of Section IX included in this project’s bid documents. This includes complying with all applicable parts of the Davis-Bacon and related Acts. We pledge to pay all employees working on this project at least the prevailing wages as described for their classification of work outlined in the Section IX General Decision Number PA PA20260002 01/30/2026, as part of the bid documents. Our firm is fully aware of the protocols and processes involved in complying, such as but not limited to weekly certified payrolls and the accompanying form WH-347. This document includes a signed Statement of Compliance with each and every payroll submission.

Signature (Owner/President) Date

E. CERTIFICATION REGARDING DEBARMENT

F. MBE/WBE SECTION 3 SOLICITATION & COMMITMENT STATEMENT

Lawrence County is committed to promoting full participation by low‑ and very low‑income persons, as well as business concerns that provide economic opportunities to them, in its Community Development Block Grant (CDBG) and HOME Programs.

The County has developed a Section 3 Action Plan outlining the goals, objectives, and actions required to ensure full compliance with Section 3. The plan will continue to be refined with input from municipal departments, the Pennsylvania Department of Community and Economic Development (DCED), and—when appropriate—other agencies and companies. This collaborative approach ensures that the plan remains comprehensive, effective, and aligned with community needs.

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