4-Statement of Bidders Qualifications.pdf

CONTRACT NO._____________________ WIFIA Project Bid Book (REV. 3/22)

PROJECT: CASCADE WELLS 6A AND 6B WELL CHLORINATION PAGE: 7

(C) STATEMENT OF BIDDERS QUALIFICATIONS

CASCADE WELL 6A AND 6B CHLORINATION SYSTEM, CIPWT00C36

The Bidder shall provide the information described in this section or their bid may be considered non-responsive. The Bidder may submit additional information beyond that requested below to demonstrate the Bidder’s qualifications.

A. Company Name: _____________________________________________________________ B. Company Address: ___________________________________________________________ C. Company Email: _____________________________________________________________ D. Company Phone: ____________________________________________________________ E. Is your company licensed and bonded in the State of Oregon and has your company complied with all Oregon Administrative Rules (OAR) for Well Construction and Maintenance and Well Construction Standards including OAR 690-200-005 through OAR 690-210-420? (Circle One)

1. Yes

2. No

F. Has your company performed work on at least three (3) water supply well projects involving wells completed in alluvial formations with two or more of the following characteristics, at a minimum: total contract value of >$500,000, total well depth >800 feet, production well casing diameter >20-inches (Circle One and Complete)

1. Yes

a. Project #1

1. Name of Project: ______________________________________________

2. Client Name and Phone Number: __________________________________

b. Project #2

1. Name of Project: _______________________________________________

2. Client Name and Phone Number: __________________________________

c. Project #3

1. Name of Project: _______________________________________________

2. Client Name and Phone Number: __________________________________

2. No G. Does your project team for this well have a lead driller with at least 10 years of experience constructing municipal water supply wells that was the lead driller on one or more of the projects listed above? (Circle One and Complete)

1. Yes

a. Name and Title/Position: ___________________________________________

b. Years of Experience: ______________________________________________

c. Oregon Water Well License No. _____________________________________

2. No H. Bidder attests that:

1. The person submitting this offer has the authority to submit the offer and to represent Bidder in all phases of this procurement process;

2. The information provided herein is true and accurate;

3. Bidder is a “resident bidder”, as described in ORS 279A.120 in the State of Oregon, or is a

“non-resident bidder” of ______________ (insert state) and has not discriminated against any minority, women, or emerging small business enterprises in obtaining any required subcontracts in accordance with ORS 279A.110. Non-resident bidder also agrees to report their participation in this contract, if awarded, to the Oregon Department of Revenue as required by ORS 279A.120 (3).

4. Any false statement may disqualify this offer from further consideration or be the cause of contract termination;

CONTRACT NO._____________________ WIFIA Project Bid Book (REV. 3/22)

PROJECT: CASCADE WELLS 6A AND 6B WELL CHLORINATION PAGE: 8

5. Bidder has the appropriate financial, material, equipment, facility, personnel resources, and expertise or the ability to obtain the resources and expertise necessary to meet all contractual responsibilities;

6. Bidder has an employee drug testing program in place as required by ORS 279C.505 (2);

7. If awarded a contract, Bidder will notify the City within 15 days of any change in information provided on this form.

I. The undersigned hereby authorizes and requests any person, firm, or corporation to furnish any information requested by the City of Gresham in verification of recitals comprising this Statement of Bidder’s Qualifications. I hereby certify that the answers to the foregoing statements attached hereto including any supplemental data, are true and correct to the best of my knowledge. (Complete)

1. Signature: ____________________________________________________________

2. Name and Title/Position: ________________________________________________

3. Company Name: ______________________________________________________

4. Date: _______________________________________________________________