5-BIDDERS QUALIFICATIONS.pdf

CONTRACTOR’S QUALIFICATION STATEMENT

All questions must be answered and the date given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate attached sheets. The Bidder may submit additional information if he so desires.

The Undersigned certifies under oath that the information provided herein is true and sufficiently complete so as not to be misleading.

Submitted to:

Address:

Submitted by:

Corporation:

Name:

Partnership:

Address:

Individual:

Principal Office:

Other:

Name of Project (if applicable)

Type of Work (file separate form for each Classification of Work):

General Construction

HVAC

Plumbing

Electrical

Other (please specify)

1. ORGANIZATION

1.1

How many years has your organization been in business as a Contractor?

1.2

How many years has your organization been in business under its present business name?

1.2.1 Under what other or former names has your organization operated?

1.3

If your organization is a corporation, answer the following:

1.3.1 Date of incorporation:

1.3.2 State of incorporation:

1.3.3 President's name:

1.3.4 Vice-president’s name:

1.3.5 Secretary’s name:

1.3.6 Treasurer’s name:

1.4

If your organization is a partnership, answer the following:

1.4.1 Date of organization:

1.4.2 Type of partnership (if applicable):

1.4.3 Name(s) of general partner(s):

1.5

If your organization is individually owned, answer the following:

1.5.1 Date of organization:

1.5.2 Name of owner:

1.6

If the form of your organization is other than those listed above, describe it and name the principals:

2.

LICENSING

2.1

List jurisdictions and trade categories in which your organization is legally qualified to do business, and indicate registration or license numbers, if applicable.

2.2

List jurisdictions in which your organization’s partnership or trade name is filed.

3.

EXPERIENCE:

3.1

List the categories of work that your organization normally performs with its own forces.

3.2

Claims and Suits: (If the answer to any of the questions below is yes, please attach details).

3.2.1 Has you organization ever failed to complete any work awarded to it?

3.2.2 Are there any judgments, claims, arbitration proceedings or suits pending or outstanding against your organization or its officers?

3.2.3 Has your organization filed any law suits or requested arbitration with regard to construction contracts within the last five years?

3.3

Within the last five years, has any officer or principal of your organization ever been an officer or principal of another organization when it failed to complete a construction contract?

3.4

On a separate sheet, list major construction projects your organization has in progress, giving the name of project, owner, architect, contract amount, percent complete and scheduled completion date.

3.4.1 State total worth of work in progress and under contract:

3.5

On a separate sheet, list the major projects your organization has completed in the past five years, giving the name of project, owner, architect, contract amount, date of completion and percentage of the cost of the work performed with your own forces.

3.5.1 State average annual amount of construction work performed during the past five years:

3.6

On a separate sheet, list the construction experience and present commitments of the key individuals of your organization

4.

REFERENCES

4.1

Trade References:

4.2

Bank References:

4.3

Surety:

4.3.1 Name of bonding company:

4.3.2 Name and address of agent:

5.

FINANCING:

5.1

Financial Statement:

5.1.1 Attach a financial statement, preferably audited, including your organization’s latest balance sheet and income statement showing the following items:

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

Net Fixed Assets;

Other Assets:

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

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

5.1.4 If not, explain the relationship and financial responsibility of the organization whose financial statement is provided (e.g., parent-subsidiary).

5.2

Will the organization whose financial statements attached act as guarantor of the contract for construction?

6.

AFFIRMATIVE ACTION PROGRAM

6.1

Each bidder must provide with his/her proposal a written statement describing the exact nature scope and history of their Affirmative Action Program in the interest of extending work opportunities to qualified minority workers.

6.2

Failure of a bidder to provide information as required under this paragraph may be cause for disqualification of the bidder’s proposal.

7.

APPRENTICESHIP TRAINING

7.1

A bidder shall be a participant in a state or federally approved Apprenticeship Training Program. Each bidder shall submit with his/her proposal a complete description of the Apprenticeship Training Program in which the bidder participates, including a list of the number of graduated apprentices every year for the past five years.

7.2

If requested by the Owner, the bidder shall submit within three days of the date of the request, the name, address, and telephone number of the state and federal agency which certifies the bidder’s Apprenticeship Training Program and the bidders identification number (if any) that would enable the Owner’s representative to verify the information provided by the bidder.

7.3

Failure of a bidder to provide information as required under this paragraph may be cause for disqualification of the bidders proposal.

8.

INSURANCE

Proof and submission of a description of any health care plans, worker’s compensation insurance and unemployment insurance maintained for the benefit of the contractor’s employees.

9.

Proof that the Contractor is not presently debarred by Federal, State or Local Authorities, and a history containing a full and complete description of events underlying any debarment with in the prior 10 year period.

10.

Proof that the Contractor has not defaulted on a project, trade or contracting license or been suspended or revoked and has not violated any prevailing wage laws.

11.

SIGNATURE

Dated at this ________ day of ____________________________________

Name of Organization: _____________________________________________

By: _____________________________________________________________

Title: ___________________________________________________________

____________________ being duly sworn deposes and says that the information provided herein is true and sufficiently complete so as not to be misleading

Subscribed and sworn before me this day of _____________________________________

My Commission Expires: _________________________________________