4-RFB 2025-066 Prequalification Form.pdf

PREQUALIFICATION APPLICATION

Request is hereby made to prequalify to bid on the SS298/Franklin Avenue Relocation Project

Company Name:

By:

Title:

Telephone ( ) e-Mail

Date:

This form shall be submitted to:

CITY OF WACO

PURCHASING SERVICES

PO BOX 2570

WACO, TEXAS 76702

SUMMARY OF ATTACHMENTS TO BE PROVIDED

A. Firm history B. Individuals that visited site or assisted in preparation of prequalification package C. Resumes and experience of key personnel D. Organizational chart E. Description of work to be completed by bidding organization F. Major subcontractors G. Construction projects currently under construction H. Bidding Organization’s similar projects I. Safety program J. Lost day accident report

A. GENERAL

1. Organization Doing Business As:

Business Address:

Telephone Number: ( ) e-mail:

Indicate as Applicable: Corporation

Partnership

Sole Proprietorship

Principal Office Location:

Address:

Contact Person:

Telephone Number: ( ) e-mail:

2. If a CORPORATION:

Date of Incorporation:

State of Incorporation:

Chief Executive Officer’s Name:

President’s Name:

Vice President’s Name(s):

Secretary’s Name:

Treasurer’s Name:

3. If a PARTNERSHIP:

Date of organization:

State whether partnership is general or limited:

Name and address of each partner:

4. If a SOLE PROPRIETORSHIP:

Name and business address:

5. Provide a brief history of the organization and attach to this form. Labeled as “Attachment

A”. This attachment should include, at a minimum:

Parent company name, if applicable Other names Bidding Organization is currently using, or has used in the past Years of experience in the industry

6. PRE-BID VISIT REQUIREMENT: Name and title of individuals from your organization who have visited the site of the work and the date they visited the site, individuals who reviewed the Prequalification package, assisted in preparation of the Prequalification package (other than typing). The following individuals shall also be named: Authorized Signatory, Estimator, and Project Manager. If necessary, attached a separate sheet, labeled as “Attachment B”.

7. Is your organization legally qualified to do business in Texas?

8. How many persons are employed full-time by your company?

B. EXPERIENCE & EQUIPMENT

1. Key Personnel Experience: Provide qualifications of the project personnel who will perform key functions. Label as “Attachment C”. Minimum information to be contained on the resume* of each individual, if applicable, shall include: years with Bidding Organization, total years of related technical experience, managerial experience, education, position occupied on each assignment, description of duties on each assignment, professional registration and certification, professional societies and affiliations and number of years of related experience with the organization. The following positions on your project team shall be identified at this time and shall be binding throughout the duration of the project unless otherwise approved by the City of Waco.

KEY PROJECT PERSONNEL – GENERAL CONTRACTOR

Principal-in-Charge

Dedicated Project Manager (committed to, and performing, the work) Dedicated Project Superintendent (Site Superintendent) Dedicated Safety Officer

(*Resumes shall include (1) where person was employed for the last ten years, (2) detailed projects and experience for the last ten years, and (3) any information/experience noted in Section V (“Prequalification Process and Review”) of the Request for Bids)

2. Organizational Experience

a) How many years has your organization been in business as a construction company under your present business name? ____________________________________________

b) List any other names your organization has, does or anticipates operating under, including the names of related companies presently doing business:

c) How many years of experience in the proposed type and size of construction work has your organization had?

1) As a General Contractor:

2) As a Joint Venture Partner:

3) As a Subcontractor:

d) Describe at least two (2) projects within the last eight (8) years for which the Bidding Organization completed the following work (include pictures if applicable and contact info for reference check):

Installed water and/or wastewater lines of at least 16” in size with a total construction value of at least $7 million.

a. Project Name & Location: ___________________________________________

Owner Contact Information:__________________________________________

Contractor Role:

Project Cost: ______________________________________________________

Project Completion Date:_____________________________________________

Description of Project:

How project is similar in complexity and scope of work to the SS298/Franklin

Avenue Relocation project:

b. Project Name & Location: ___________________________________________

Owner Contact Information:__________________________________________

Contractor Role:

Project Cost: ______________________________________________________

Project Completion Date:_____________________________________________

Description of Project:

How project is similar in complexity and scope of work to the SS298 Project:

Indicate in what capacity (i.e. as performing main contractor, main contractor managing a specialist/sub-consultant, or specialist/sub-consultant) you performed the above work:

e) Describe at least two (2) projects within the last eight (8) years for which the Bidding Organization or a “Major Sub-Contractor” completed the following work (include pictures if applicable and contact info for reference check):

Installed a water or wastewater line by auger bore of at least 24” in size casing pipe.

c. Project Name & Location: ___________________________________________

Owner Contact Information:__________________________________________

Role: ____________________________________________________________

Project Cost: ______________________________________________________

Project Completion Date:_____________________________________________

Description of Project:

How project is similar in complexity and scope of work to the SS298 Relocation project:

d. Project Name & Location: ___________________________________________

Owner Contact Information:__________________________________________

Role: ____________________________________________________________

Project Cost: ______________________________________________________

Project Completion Date:_____________________________________________

Description of Project:

How project is similar in complexity and scope of work to the SS298 project:

Indicate in what capacity (i.e. as performing main contractor, main contractor managing a specialist/sub-consultant, or specialist/sub-consultant) you performed the above work:

f) Describe at least one (1) project within the last ten (10) years for which the Project Manager has completed the following work (include contact info for reference check):

Installed water and/or wastewater lines of at least 12” in size with a total construction value of at least $5 million.

e. Project Name & Location: ___________________________________________

Role: ____________________________________________________________

Project Cost: ______________________________________________________

Project Completion Date:_____________________________________________

Description of Project:

How project is similar in complexity and scope of work to the SS298 project:

f. Project Name & Location: ___________________________________________

Role: ____________________________________________________________

Project Cost: ______________________________________________________

Project Completion Date:_____________________________________________

Description of Project:

How project is similar in complexity and scope of work to the SS298 project:

g) Describe at least one (1) projects within the last ten (10) years for which the Project Superintendent has completed the following work (include contact info for reference check):

Installed water and/or wastewater lines of at least 12” in size with a total construction value of at least $5 million.

g. Project Name & Location: ___________________________________________

Role: ____________________________________________________________

Project Cost: ______________________________________________________

Project Completion Date:_____________________________________________

Description of Project:

How project is similar in complexity and scope of work to the SS298 project:

h. Project Name & Location: ___________________________________________

Role: ____________________________________________________________

Project Cost: ______________________________________________________

Project Completion Date:_____________________________________________

Description of Project:

How project is similar in complexity and scope of work to the SS298 project:

3. Organizational Structure

a) Provide a brief description of the structure of your organization with a block schematic diagram (i.e., organizational chart). Include titles and names of key personnel. Label as “Attachment E”.

b) In the past ten years, has any officer or partner of your organization been an officer or partner of some other organization that failed to complete a construction contract?

(Include the specific year(s) of the occurrence(s) in your answer.)

If so, state name of individual, current title, other organization and provide details:

c) In the past ten years, has any officer or partner of your organization failed to complete a construction contract for which he was Principal-in-Charge, Project Manager or Project Superintendent? (Include the specific year(s) of the occurrence(s) in your answer.)

If so, state name of individual, current title and provide details:

d) In the past ten years, has your organization failed to complete any work awarded to it?

(Include the specific year(s) of the occurrence(s) in your answer.)

If so, provide details:

e) In the past 10 years, has your organization been released from a bid? (Include the specific year(s) of the occurrence(s) in your answer.) _______________

If so, list the name of the project, owner’s name, address, phone number and state the reasons for each occurrence:

f) Is your organization currently engaged in litigation with respect to any claim regarding contract performance?

g) In the past ten years, has your organization been assessed liquidated damages? (Include the specific year(s) of the occurrence(s) in your answer.)

If so, provide details, including the project name, contact name, phone number and owner’s name, address and phone number:

h) In the past ten years, has your organization had a contract terminated for cause? (Include the specific year(s) of the occurrence(s) in your answer.) ________________________

i) In regards to questions b) through h); have any of these occurred with the City of Waco?

If so, provide details about the project; circumstances in which this occurred; and the final outcome or resolution.

j) What percentage of this project do you, as the general contractor, anticipate performing?

k) Provide a description of the Work that will be completed by your organization’s work force for this project. If additional space is needed, label “Attachment F”.

l) MAJOR SUB-CONTRACTORS - Provide a listing of “Major” subcontractors that your company proposes to utilize for the requested project. Contractors may not have selected their sub-contractors by this time and are therefore allowed to submit multiple sub-contractors for review under each “major” scope of work item. The Contractor will be provided a list of approved sub-contractors for each “major” scope of work item when notified of their prequalification status (Pass or Fail). The Contractor’s final selection of a sub-contractor for each “major” work item must come from this approved list.

“Major” subcontractors are defined as any contractor installing: 1) Installation of Water and/or Wastewater Pipe 12” or larger, 2) Auger Bore (If additional space is required, include as “Attachment G”).

For each sub-contractor, provide the resumes of key project personnel (see Item B.1 for required information), the company name, scope of work to be performed on this project, contact information, brief description of proposed services, key staff, years in business, and at least three projects in the last ten years with similar work and complexity to this Project. The three projects must each include the project name, location, description, completion date, construction cost, pictures (if available), how the project relates to SS298 Relocation Project in complexity and scope of work, and a reference name and contact information.

KEY PROJECT PERSONNEL – SUB-CONTRACTORS

Dedicated Project Manager (committed to, and performing, the work)

Dedicated Project Superintendent (Site Superintendent)

(*Resumes shall include (1) where person was employed for the last ten years, (2) detailed projects and experience for the last ten years, and (3) any information/experience noted in Section V (“Prequalification Process and Review”) of the Request for Bids)

m) What construction projects does your organization currently have under contract?

Provide the name and location of each project, name of owner and their construction manager, description of project, the anticipated completion date, contract amount and list of current disputes and/or claims. (If additional space is required, include as “Attachment H”).

List any other business(es) your organization actively participates in?

4. Equipment

a) List the major types of construction equipment your organization would propose to use on the proposed work:

b) Which of these items of equipment does your organization own, and state whether or not this equipment will be available when needed for the proposed work?

c) List the major items of equipment which your organization would typically lease:

C. CONTRACTOR’S FINANCIAL STATUS

Attach documentation showing that a bonding company will issue performance and payment bonds to the submitter if the contract is awarded. The bonding company must meet the following standards: complied with the laws and regulations of the U.S. Department of the Treasury under Title 31 U.S.C. 9304-9308 of the United States Code (“T-listing”) and be included as an acceptable surety on federal bonds in the Department of the Treasury’s Listing of Approved Sureties (Department Circular 570).

1. What is your organization’s approximate total bonding capacity?

Approximately what percentage is currently committed to other work?

2. What is the name, address, and telephone number of your organization’s primary bonding company?

3. Does your organization intend to use this company as Surety?

If not, who does your organization intend to use? Provide Surety’s name, address and telephone number.

D. SAFETY RECORD

1. Describe the permanent safety program maintained within your organization. (Provide your organization’s prepared safety statement, program or policy, if available, and label as “Attachment I”).

2. What is the approximate total dollar value of OSHA safety violation citations charged against your organization over the past five years?

3. Provide specific details for each OSHA citation received within the past five years.

4. Include a lost day accident report over the last three years for the job site project manager listed in Section B. (If additional space is required, include as “Attachment J”).

E. AFFIDAVITS

AT LEAST ONE OF THE FOLLOWING THREE AFFIDAVITS MUST BE EXECUTED. ANY AFFIDAVIT THAT IS NOT

APPLICABLE TO YOUR ORGANIZATION SHOULD BE LEFT BLANK.

F. INSURANCE

Insurance and Indemnification requirements are listed in Appendix C for this Request for Bids. By checking the box below, you certify that you will meet the minimum insurance requirements listed in Appendix C and that, if awarded the contract for the SS298/Franklin Avenue Relocation Project, you will provide your Certificate of Insurance to the City of Waco and fulfill all other insurance requirements listed in Appendix C.

☐ I certify the above statement.

PREQUALIFICATION APPLICATION:

AFFIDAVIT FOR CORPORATION (1)

State of § County of §

, being duly sworn deposes and states:

That he/she is of the , the corporation submitting the foregoing statement of experience and financial condition; that he/she has read the same;

and that the same is true and correct.

Signature

Signed and sworn to before me this day of, 20

Notary Public

My commission expires:

Note: Use full corporate name and attach corporate seal.

AFFIDAVIT FOR PARTNERSHIP (2)

, being duly sworn deposes and states:

That he/she is of the , the partnership submitting the foregoing statement of experience and financial condition; that he/she has read same; and that same is true and correct.

Note: Use full corporate name and attach corporate seal.

AFFIDAVIT FOR SOLE PROPRIETORSHIP (3)

, being duly sworn and deposes and states:

That he/she the person submitting the forgoing statement of experience and financial condition; that he/she has read same; and that same is true and correct.