5-Attachment B.pdf

IFB 2000004066

Attachment B-1

REFERENCES

Provide a minimum of three (3) references from similar projects/jobs where work was performed, within the past three (3) years for isolation valve replacement and in-line flushing valve replacement, at the valve sizes and depths proposed.

Fairfax County Government (FCG), and Fairfax County Public Schools (FCPS), to include all agencies and authorities, shall be considered as a single entity (one reference) for the purpose of these references.

Reference 1

Customer Name Project/Job Name

Address Date of Work

Size and Length of Project

Contact Name Title

Telephone Number Email

Description of the scope of work

Reference 2

Reference 3

Attachment B-2

RELATED EXPERIENCE AND OTHER INFORMATION

1. Provide proof of work history in North America that includes temporary bypass of low-pressure force main; replacement of isolation valves and appurtenances; replacement of in-line flushing valves and appurtenances; inspection and testing; clean-up; and all miscellaneous work as specified in the Technical Specifications.

2. Have must have been in business in North America for a minimum of three (3) years, and must have successfully completed, within North America, a minimum of three (3) sanitary sewer, water or sewer pressure pipe installation and/or maintenance projects of similar size and scope.

3. Bidders shall complete and submit Contractor's Experience Record to provide to a list of at least three

(3) similar projects/jobs completed within the last three (3) years for isolation valve replacements.

Complete the Contractor’s Experience Record Form, listing the following: size(s) and depth(s) of the replaced valve for each project; total dollar value; and notate date of each project and reference(s) for each project to include names, addresses, and telephone numbers.

4. Provide the proposed Superintendent-in-Charge of the installation with a minimum of five (5) years of experience prior to bid opening in the installation of isolation valves and in-line flushing valves in North America. The proposed superintendent-in-charge shall have successfully installed a minimum of three

(3) sanitary sewer, water or sewer pressure pipe installation and/or maintenance projects in North America of similar size and scope proposed in this solicitation prior to bid opening. Provide information about project experience of the proposed contract’s Project Superintendent using the Superintendent’s Experience Record form. In addition, describe this individual’s proposed responsibility.

5. Project Management Ability: Explain plans to staff and operate the project. The bidder shall include an organizational chart stating job titles, responsibilities and the number of years of experience.

6. Manufacturers And Products Record:

a. Manufacturer(s) must have been in business in North America for a minimum of five (5) years. They must have successful production and installation of isolation valves and in-line flushing valves. The bidder must provide documentation satisfying this criterion.

7. Subcontracted Services:

Identify Subcontractor firms and list their role and their portion of the work below. If subcontractor(s) specific to this project cannot be identified at this time, the Bidder shall complete the information for firms used in the recent past and define this on the completed Item:

Name of Firm:

Proposed work to be performed on this project:

Approximate percentage of total proposed project scope:

Provide, as additional attachments, the name of each firm and the firm’s qualifications for firms that the Bidder will use as Subcontractors for this Project.

Provide resumes of individuals from the firms whom the Subcontractors will use for completion of the replacement work.

Superintendent’s Experience Record (Attach Additional Copies of This Form as Necessary)

Page _____ of _____

Name of Bidder: _________________________________________ Name of Superintendent-in-Charge: _______________________________________________

Name of Location of Project Sizes, Depths and Numbers of Isolation Valves Installed

Completion Date (mm/yy)

Total Cost of Project

Client Reference

Name:

Organization or Company:

Address:

Phone No.:

Contractor’s Experience Record (Attach Additional Copies of This Form as Necessary)

Page _____ of _____

Name of Bidder: _________________________________________

Name and Location of Project

Sizes, Depths and Numbers of Isolation Valves Installed Completion

Date (mm/yy)

Bid Cost/ Price of Project

Final or Current Cost of Project Client Reference

Name of Reference Contact

Attachment B-3

SAFETY PROGRAM AND HISTORY

A. Does your firm have a written safety program?

Yes No _____

If yes, provide details of your safety program on a separate sheet

B. Does the firm incorporate safety and health related issues into their new employee orientation programs?

C. Does the firm include work safety as a part of an employee's performance evaluation?

D. To what degree does senior/corporate management support safety related matters? Does the firm have a safety policy statement signed by a member of senior/corporate management?

Provide details on a separate sheet.

E. Does the firm have a full time Safety Manager? Does this person report to a high level, authoritative position within the Company?

If yes, provide details on a separate sheet.

F. Are safety inspections conducted at work sites? If so, how often and by whom?

G. Are safety training programs conducted for employees? If so, how often and by whom?

H. Are safety "tailgate meetings" and “toolbox meetings” conducted by the firm? If so, how frequently?

I. Does the firm have a visibly active safety committee? If so, how often does it meet? Who serves on the committee?

J. Is the firm an active member of a recognized construction safety organization in the Washington Metropolitan area, or in the state of contractor's domicile?

K. What is the firm's Workers Compensation Experience Modification Factor? Are there any evident trends?

L. In the previous three years has your firm been cited for a serious violation, willful violation, violation for failure to abate or repeated violation (as defined by OSHA)?

If yes, provide details on a separate sheet.

M. Attach OSHA form 300 and OSHA form 300A with a summary of occupation injuries and illness for the last thirty-six (36) months.

Attachment B-4

CONTRACTOR DATA SHEET

A. General Information:

1. Name and Address of Firm:

City: State: Zip:

2. Contact Person: The County may contact bidders during the evaluation of the bids to obtain clarification, if needed.

Name and Address of Contact:

Address:

City: State: Zip:

Telephone: E-Mail:

3. Years of operation under the present firm or trade name:

4. eVA Registration Number: _________________

5. Contractor’s License: Bidders are required to possess a valid Commonwealth of Virginia Contractor’s License, at the time of bid submission, to be considered a qualified bidder.

State of Virginia Contractor’s License No.: Class Type:

Date of Expiration:

Classifications (Highway, Plumbing, etc.):

B. Organization:

1. How many years has your organization been in business as a construction contractor? ______________

2. How many years has your organization been in business under its present business name and license number? ____________________

3. List license numbers, classifications and expiration dates of contractor licenses held by your firm.

4. Under what other or former names has your organization operated?

5. Organization Structure: Check One:

Corporation Partnership Sole Proprietorship Joint Venture Other

6. If a Corporation, state:

Date of Incorporation:

State in which Incorporated:

President's name: _______________________

Vice President's name(s): _______________________

Secretary's name: _______________________

Treasurer's name: _______________________

7. If a Partnership, state:

Date of Partnership:

Type of Partnership (General or Limited):

Names and Addresses of Partners:

8. If Joint Venture, state:

Date of Joint Venture:

Names and Addresses of Joint Venturers:

9. If Sole Proprietorship, state:

Name and Address of Sole Proprietor:

10. If Other than above, provide a description:

11. Is the bidder related to another firm as a parent, subsidiary or affiliate?

Yes___ No___

If yes, give names and addresses of all affiliated parent and/or subsidiary companies. Indicate which companies are subsidiaries.

12. Has there been any change in the ownership of the firm in the last three years? NOTE: A corporation whose shares are publicly traded is not required to answer this question.

Yes_______ No_________ (If “yes,” explain on a separate signed page)

C. Judgements:

1. Has the bidder or any officer, director or owner thereof had any judgments entered against him within the past ten years for breach of contracts for governmental or non-governmental construction, including, but not limited to, design-build or construction management?

Yes___ No___

If yes, provide details on any such judgment.

D. Contract Compliance:

1. Has your firm been found to be in substantial noncompliance with the terms and conditions of prior construction contracts in the past 10 years?

Yes No ______

If yes, provide details on any such instance.

2. Has the Bidder ever failed to complete any work awarded to it? If yes, state date(s), project(s), owner or A/E reference(s), and reason(s).

3. Has the bidder ever been party to a construction contract, which was terminated by the owner, for the owner’s convenience or otherwise? If yes, state date(s), project(s), owner or A/E reference(s), and reason(s).

4. Has the Bidder ever been declared to be in default or partial default on a construction contract or project? If yes, state date(s), project(s), owner or A/E reference(s), and reason(s).

5. Has the Owner or Owner’s Agent ever taken steps to complete contract work, which was the Bidder own responsibility? If yes, indicate date(s), project(s), owner or A/E references, and reason(s).

6. Has the Bidder ever been the subject of a stop work order on a construction project? If yes, state date(s), project (s), and reason(s).

7. Are there any judgments, claims, suites, arbitration proceedings, or other legal proceedings pending or outstanding to which the Bidder is a party? If yes, state date(s), project(s), and reason(s).

8. Has the Bidder filed or caused to be filed, any suits, arbitration requests or claims with regard to any construction contracts within the past five (5) years? If yes, state date(s), project (s), and reason(s).

9. Has the Bidder been assessed liquidated damages for failure to complete a project by contract date within the past ten (10) years? If yes, state date(s), project (s), and reason(s).

10. Has the Bidder ever failed to complete punch list work on time.

E. Convictions:

1. Has the bidder or any officer, director or owner thereof been convicted within the past ten (10) years of a crime related to governmental or non-governmental construction or contracting, including, but not limited to, violation of (i) Ethics in Public Contracting (Article 4 - § 11-72 et seq.), (ii) the Virginia Governmental Government (Chapter 4.2 - § 59.1 - 68.6 et seq.) of Title 59.1), or (iv) any substantially similar law of the United States or another state? If yes, provide details on any such convictions on a separate sheet.

Yes _____ No ______

F. Debarment:

1. Is the bidder or any officer, director or owner thereof currently debarred pursuant to an established debarment procedure from bidding or contracting by any public body, agency of another state or agency of the federal government?

Yes _____ No ______

If yes, provide details:

Attachment B-5

FINANCIAL STATEMENT

1. Bidders must show a recent history of financial solvency and provide a financial statement. The financial statement must be independently certified and shall include your organization's latest balance sheet and income statement (stating the accounting method used) with the following items:

i. Current Assets (e.g., cash, joint venture accounts, accounts receivable, notes receivable, accrued income, deposits, materials inventory, and prepaid expenses);

ii. Net Fixed Assets;

iii. Other Assets;

iv. Current Liabilities (e.g., accounts payable, notes payable, accrued expenses, provision for income taxes, advances, accrued salaries, and accrued payroll taxes);

v. Other Liabilities (e.g., capital, capital stock, authorized and outstanding shares par values, earned surplus, and retained earnings);

vi. Name and address of firm preparing attached financial statement, and date thereof;

vii. State whether the Contractor has ever had a Bankruptcy Petition filed in its name, whether voluntarily or involuntarily. If yes, specify the date, circumstances, and resolution;

viii. State whether the Contractor is currently in default on any loan agreement or financing agreement with any bank, financial institution, or other entity. If yes, specify details, circumstances;

ix. Provide current credit rating information